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Company information
Company number:*
VAT number:*
Company name:*
General e-mail address:*
Visiting address
Street and house number:*
Zip code:*
City:*
Country:*
Delivery address
Same as visitor address:*
Street and house number:*
Zip code:*
City:*
Country:*
Copaco does not deliver to PO boxes.
Invoice address
Same as visitor address:*
Street and house number:*
Zip code:*
City:*
Country:*
Customer before
Have you been a Copaco customer before?:*
What was your customernumber?:*
Contact data
Title:*
First name:*
Surname:*
Initials:*
Occupation:*
Phone number:*
E-mail address:*
Remarks
Sign and send
I have read the general conditions and the e-business agreement and declare that I agree with these conditions. I garantee that all information supplied is complete and correct.
IBAN:*
BIC:*