Forgot your password?

• Home
• News
  • Agenda
• About us
  • Discount scheme
  • Lavera
  • Marketing opportunities 2020
  • Marketing opportunities 2021
  • Shelf plan
  • Licenses
• Information fair
  • Visitor
  • Exhibitor
• Assortment
  • Search
  • New
  • Price changes
  • Price changes (history)
  • Special offers
• Order
• Contact
  • Become a customer
  • Frequently asked questions
  • Employment opportunities

To become a customer

Are you a therapist? If so, then click here to register as a Varuvo customer.

Application Form

Company name:
Kind of customer:		Pharmacy General practitioner with pharmacy Veterinarian Drug store Wholesale Herbal shop Supplier Market vendor Natural store Health food store (Organic) Supermarket Webshop
Medical license?:		yes   no
Copy Medication License (JPG or PDF File):
Contact:		Not applicable Mr. Mrs.
Afleveradres Postal code: Town/village: Streetname: Housenr.: Factuuradres (indien afwijkend van afleveradres) Postal code: Town/village: Streetname: Housenr.:
Telephonenr.:
E-mail contact:
E-mail invoices:
E-mail newsletters:
Website:
VAT number:
Optional remarks:

After the registration, we will send an authorization for direct debit. For direct debit, a 1% discount will apply to invoice (we collect within 5 days of invoice date).

 

I agree with our general sales and delivery terms and with the arrangement as stated on this form. Required fields are marked with a *

Become a customer General sales and delivery terms Privacy statement Copyright © 2017 Holland Pharma

Follow us

CONTACT Holland Pharma Bosberg 41 7271 LE Borculo +31 (0)545 25 10 50 info@hollandpharma.nl