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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

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