AMICA SYSTEMS

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About Amica

general info

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Customer application form
1. Complete all sections of the trade application from on line. 2. Print the resulting Customer Application Form and sign this printout. 3. fax the signed from to Amica on +1 (510) 9790600, along with a copy of your business letterhead and a copy of your VAT registration certificate. 4. If you have any queries, please do not hesitate to contact the Amica sales team by telephone. For contact details please click here
Company details:

Company name: *
Company address: *
City: *
Postcode: *
Country: *
Telephone number: *
Fax number:
Web Address:
Date of incorporation: *	(YYYY-MM-DD)
Type of Company: *	Dealer System Builder Distributor Manufacturer Retailer Var (Value added reseller)
Vat-number: *
Date last financial statement:	(YYYY-MM-DD)
Management Details:
Name Director: *
Telephone Number: *
Fax Number:
Address:
City:
Postcode:
Country:
Email Address: *	I want to receive newsletter
Name Sales Contact:
Telephone number:
Fax number:
Shipping Details:
Shipping Address:
City:
Postcode::
Country:
Authorized persons to sign for receipt:
Name contact:
Telephone number:
Fax number:
Bank details
Bank name:
Address:
City:
Postcode::
Telephone number:
Fax number:
Bank account number:
Swift code:
Name contact for payments:
Telephone number:

Welcome to Amica

Customer application form