Nord Micro AG&Co OHG

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New customer questionnaire
We ask you to fill in this form, the data is needed to create
an IT-System customer account for your company.

Full company address

company:*

street:*

street number:*

postal code:*

city:*

country:*

Full delivery address

company:*

street:*

street number:*

postal code:*

city:*

country:*

Invoice address

company:*

street:*

street number:*

postal code:*

city:*

country:*

VAT number
(if applicable)*:

Customs Tariff Number (Non-EU)
(if applicable)*:

Tax Number (Germany)
(if applicable)*:

Preferred currency

USD

EUR

Contact person/contact datas

salutation:

Mr.

Mrs.

first name:*

last name:*

fon:

e-mail:*

Your freight forwarder/account number

first name:

last name:

account number:

* mandatory field