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Request new user

Please complete the form below (fields marked * are required).

First name*
Family name*
Gender* MaleFemale
E-mailaddress*
Employee Number (EIN)*
Division*
Are you a manager?* YesNo
Managers name*
Managers e-mailaddress*
Employee Number Manager (EIN)*

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STANDARD SHIP TO ADDRESS

Company name*
Street + number*
Zip code*
City*
Country*

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INVOICE ADDRESS

Company name*
Street + number*
Zip code*
City*
Country*
VAT number*


Your manager wil receive an email to approve your account. After we receive the approval we will send you your log in data.

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Momenteel is er geen medewerker beschikbaar. We zijn er voor u tussen 7.30 - 21.00 uur. U kunt altijd mailen naar info@wiltec.nl.
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