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Business Request Form
COMPANY
Country
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Company name
*
*
Enterprise number
*
PRIMARY CONTACT
First name
*
*
Last name
*
*
Function
*
General manager
Administration manager
Logistics manager
Sales Manager
Sales Executive
Support manager
Marketing manager
Installer
Programmer
Architect
Interior Designer
Project Manager
Private Customer
Other
Gender
*
Male
Female
Neutral
Email
*
*
*
Mobile phone
*
*
Needs Basalte World?
*
Needs Basalte World?
No
Needs Basalte World?
Yes
Language
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SHIPMENT ADDRESS
Street + no.
*
Postal code/ZIP (ship-to)
*
City (ship to)
*
Country (ship to)
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BANK DETAILS
Bank name
*
IBAN
*
(swift)
*
COMPANY DETAILS
Date of establishment
*
Showroom?
Showroom?
No
Showroom?
Yes
Showroom details
*
Total no. of employees
*
*
No. employees home automation
*
No. residential projects / year
*
Type of projects
*
General annual turnover
*
% home automation turnover
*
Main phone
*
*
VAT number
*
*
ADDITIONAL CONTACT
First name
*
Last name
*
Function
General manager
Administration manager
Logistics manager
Sales Manager
Sales Executive
Support manager
Marketing manager
Installer
Programmer
Architect
Interior Designer
Project Manager
Private Customer
Other
Gender
Male
Female
Neutral
Email
*
*
Mobile phone
*
Needs Basalte World?
Needs Basalte World?
No
Needs Basalte World?
Yes
INVOICE ADDRESS
Invoice address
*
Street + no.
*
Postal code/ZIP
*
City
*
Email for e-invoices
*
*
SHORT DESCRIPTION OF MAIN ACTIVITIES
activity description
*
MAIN BRANDS
Home automation
*
Lighting
*
AV solutions
*
Exclusive dealer
*
Business request ID
*
Please enter your unique Business Request ID that you've recieved within the invitation e-mail (this must be a 6 digit code)
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