Registration order for compliant sales in Belgium

Company Data

Are you an existing customer or a new customer?*

Existing customer

New customer

This field must be filled!

Neukunde

Name of company*

This field must be filled!

Street and number*

This field must be filled!

Zip*

This field must be filled!

City*

This field must be filled!

Country*

This field must be filled!

Other country*

This field must be filled!

Website (if available)

This field must be filled!

Foundation date*

VAT number of the company you wish to register*

This field must be filled!

Are you listed in the commercial register?*

Yes

This field must be filled!

Company registration number*

This field must be filled!

Company is registered at*

This field must be filled!

Business license*

Bestandskunde

Customer number*

This field must be filled!

Name of company*

This field must be filled!

Foundation date*

E-mail address for this registration order*

This is not a valid email address!

Telephone number for follow up questions regarding the registration order

This field must be filled!

Personal Data

Authorised signatory

Please note:

It is essential that the authorised signatory must be stated in the business licence.
It is essential that the person named is an authorised signatory.
In the case of a battery registration, the person authorised to sign will be contacted by the Belgian take-back scheme as part of the registration process. The participation of this person is mandatory for a successful registration.

Gender*

Mr.

Mrs.

This field must be filled!

Last name*

This field must be filled!

First name*

This field must be filled!

Position*

This field must be filled!

Tel. No.*

This field must be filled!

E-mail address*

This is not a valid email address!

Authorised signatory outro

Receipt of invoice

E-mail address for receiving invoices*

This is not a valid email address!

Contact person

Are the authorised signatory and the contact person two different people?*

Yes

This field must be filled!

contactperson

Gender*

Mr.

Mrs.

This field must be filled!

Last name*

This field must be filled!

First name*

This field must be filled!

Tel. No.*

This field must be filled!

E-mail address*

This is not a valid email address!

Distribution in Belgium

Do you have a local branch in Belgium?*

Yes, I have a branch in this country and sell through it.

Yes, I have a branch in this country but do not sell through it.

Yes, I have a branch and I sell both through this branch and through the company specified in the company data.

No, I do not have a branch in this country.

This field must be filled!

Does your company have a Belgian VAT number and sells via this number in Belgium?*

Yes

This field must be filled!

Please insert your Belgian VAT number.*

This field must be filled!

Products*

This field must be filled!

Submit data

With which take-e-way consultant have you been in contact?*

This field must be filled!

SEPA

SEPA Direct Debit Mandate for recurrent payment

To make your payment process easier, we recommend payment via SEPA direct debit.

Creditor
take-e-way GmbH
Schlossstr. 8 d-e, 22041 Hamburg, Germany

Creditor identifier: DE58ZZZ00000031323
Mandate reference: Will be advised by take-e-way later

Debitor:

Name of debitor / Company name*

This field must be filled!

Street and number*

This field must be filled!

Zip*

This field must be filled!

City*

This field must be filled!

Country*

This field must be filled!

Other country

This field must be filled!

IBAN*

This is not a valid IBAN number!

BIC*

This field must be filled!

Name of the bank*

This field must be filled!

Alternate account holder

This field must be filled!

I/We herewith declare my/our participation in the take-e-way direct debit order procedure and authorize take-e-way revocably to collect the payments, which I/we need to make for the rendered services on maturity at the expends of my/our account by means of direct debit order procedure. I/We would like to ask you to immediately submit collection receipts to my/our above mentioned bank on the date of invoice. I/We will make provisions for sufficient account coverage on time. This authorization is valid until it is revoked towards take-e-way in writing. As a matter of fact, I/we assure the completeness and correctness of the above data.

This field must be filled!

By signing this mandate form, you authorise take-e-way GmbH to send instructions to your bank to debit your account and your bank to debit your account in accordance with the instructions from take-e-way GmbH. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.

This field must be filled!

submit outro

SEPA direct debit is not desired/possible.

This registration order is part of the International Service Contract and subject to the terms and conditions stated therein. With submission by the producer, it becomes an integral part of the contract. take-e-way GmbH confirms to check the possibilities of a registration according to the previously given information and to commission it if necessary. Should a registration not be possible or necessary, the producer will be informed about this. Please note that only by signing the International Service Contract the registration process will be started.

This field must be filled!

Please select at least one contract type for which you would like to send us your data.

I accept the Data Protection Declaration. I consent to my details and data being collected and stored electronically in order to respond to my enquiry. You can revoke your consent for the future at any time by emailing info@take-e-way.de.*