Clone of Customer Onboarding Form

Customer Application Form

Please fill in as complete as possible. That way we will have your account set-up in no time.
General company information
Company Name*
Address and housenumber *

Street and house No.

Straat en Huisnummer 2e regel

CityStaat / Provincie

Postcode
Postcode*
Postcode
City*
City
Country*
Country
Country
VAT number*
Chamber of Commerce registration number (SIREN for France / Steuer No. for Germany)
Your Website
Owners Name*

First NameLast Name
General Phone No.*
Telephone No.
Buyers Name*

First NameLast Name
Mobile Phone No. *
Mobile Telephone No.
Mobile No. for WhatsApp (if different than mobile)
WhastApp No. (if different than mobile)
E-mail for orders*
E-mail to be used for Unidex webshop (if different than above)
Note that this mail address will be added to our mailing list automatically
E-mail address for invoices (if different from above)
What is your prefered language

EnglishDutchFrenchGermanOther
What are your opening days and hours?
(please note your opening hours per day below)

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What kind of business do you have?*

Shop / SupermarketWholesaleOther
What food- or product types do you sell?*

Dry / ambient goodsFrozenFresh fruits and vegetablesNon-FoodOther
What is your target audience / what food origins do you sell (you can check multiple boxes)

West/Central AfricanSouth/East AfricanMaghreb (North-African)Latin (ex Caribbean and Surinam)CarribeanSurinamMiddle EasternSub-ContinentalOrientalTurkishEastern EuropeanOther
Delivery and logistics
Contact person for deliveries*

First NameLast Name
Telephone number for deliveries*
Telephone number for deliveries
E-mail for deliveries*
voorbeeld@voorbeeld.com
Do you have a different address for deliveries? If so please please write here

Street and No.

Straat en Huisnummer 2e regel

CityStaat / Provincie

PostcodeCountry

What are your opening hours for deliveries. Please note your opening and closing time (for example 08:00- 17:00) Note that we can only deliver on weekdays, not in the weekend.

Rows	Open for deliveries from	Closed for deliveries at
Monday Delivery Hours
Tuesday Delivery Hours
Wednesday Delivery Hours
Thursday Delivery Hours
Friday Delivery Hours

What are your opening hours for deliveries. Please note your opening and closing time (for example 08:00- 17:00)
Note that we can only deliver on weekdays, not in the weekend.

Monday
Tuesday
Wednesday
Thursday
Friday
Can we reach you by trailer*

YesNo, only a small truck will fit
Is there a transpallet available*

YesNo, the driver needs to bring one
Does our truck need to have a taillift*

YesNo, we have a forklift / dock
Is there any additional info for deliveries?
Almost ready...
Do you have specific information or instructions you wish to share
Acceptence of Unidex's general terms and conditions

By submitting this form you declare that you have read and accepted the sales and delivery terms and conditions as per July 2024. You can find these conditions on our website by clicking here
Name*

First nameLast Name
Should be Empty:

Customer Application Form

General company information

Delivery and logistics

Almost ready...