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Application for Dealer Agreement

To evaluate a potential partnership, we would like to learn more about your company.Please complete the form below and submit your application. We will review it as soon as possible and no later than within five business days.Thank you for your interest in Espegard.
Company

Information about your company.
Organisation Number
Registered company number
Company Name
Registered legal company name
Company Email
Email address for orders and order confirmations
Company Phone

CountryCodePhone
Business

To process your application in the best possible way, please provide a short description of your current business.
Annual Turnover
Estimated turnover for the current financial year
Chain Affiliation
Does the company have agreements with retail chains?
Business Description
Short description of the company and its operations
Delivery

Please provide the delivery address and email address used when placing orders.
Delivery Address

Adresse 1

Adresse 2

CityRegion

Postal CodeCountry
Invoicing

Please specify your preferred invoicing method. A billing address is required in all cases.
Preferred Invoicing Method

Other
Invoice Email
To be completed only if invoice by email is selected
Billing Address

Adresse 1

Adresse 2

CityFylke

Postal CodeCountry
Contact Information
Contact Name

First NameLast Name
Contact Email
Contact person email address. Must not be the same as the invoicing email
Contact Phone

Country CodePhone Number
Should be Empty:

Application for Dealer Agreement