VEDARA Medical – dermocosmetics for professional and home care

Wholesaler registration form

Invoices:

domestic

european commonwealth

export

Activity description:

Attachment 1 (max 10MB):

Attachment 2 (max 10MB):

Attachment 3 (max 10MB):

Billing and shipping information

Are you a retail customer? Use the simplified registration form

Ordering as:

Individual

Company

Company name

VAT Number

Name

Surname

Street

House / flat number

Postal code

City

Country

Phone number

For courier delivery

E-mail

Delivery to another address:

First name

Surname

Company name

Street

House / flat number

Postal code

City

Country

Phone number

For courier delivery

Invoice for other data:

Company name

VAT Number

Name

Surname

Street

House / flat number

Postal code

City

Country

Login

The login must have a minimum of 3, and a maximum of 40 characters (only letters or numbers)

Password Show password

The password must be at least 6 characters long

I am an EU VAT payer. I order without VAT and I commit to settle VAT in my country.

I accept the terms of the regulations and privacy policy.

I want to receive the E-mail Newsletter (future unsubscription possible)

I want to receive SMS Newsletter (future unsubscription possible)

There are errors in the form

Connect with an existing account in another service

Wholesaler registration form

Billing and shipping information

Login