Customer Registration Form Vänligen använd endast STORA BOKSTÄVER när ni fyller i formuläret. Registered by (enter e-mail) * Customer Name * Name2 Street Address (Fill in Delivery Address if it differs from regular address) Street * House No * Postal Code * City * Country * Denmark Norway Sweden ------------- Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Street (Delivery) House No (Delivery) Postal Code (Delivery) City (Delivery) Country (Delivery) Denmark Norway Sweden ------------- Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe PO Box Address PO Box Postal Code Other City Contact Persons Contact Person * Telephone * Mobile Phone E-mail * Fill in below e-mail addresses only if the customer wants following functions by e-mail. E-mail - Invoice * E-mail Invoice reminder E-mail - Order Confirmation E-mail - Delivery Note E-mail - Consignor Track & Trace Tax Information VAT Reg. No. * Marketing Classification Industry Market Segment * AGRICULTURE CONSTRUCTION FISH INDUSTRY FOOD & BEVERAGE FORESTRY INDUSTRIAL MACHINERY AND MAINTENANCE MATERIALS HANDLING MINING OIL & GAS POWER GENERATION SHIP BUILDING & MARINES TRANSPORTATION MILITARY & DEFENSE DEALERS - AUTHORIZED Sales potential 1. > 5.000.000€ 2. ≤ 5.000.000€ 3. ≤2.500.000€ 4. ≤2.000.000€ 5. ≤ 1.500.000€ 6. ≤ 1.000.000€ 7. ≤ 750.000€ 8. ≤ 500.000€ 9 ≤ 250.000€ 10. ≤ 100.000€ 11. ≤ 50.000€ 12. ≤ 25.000€ 13. ≤ 10.000€ 14. ≤ 5.000€ 15. ≤ 2.500€ 16. ≤ 1.000€ 17. < 1.000€ 18. Unknown Sales Channel Sales Channel * MRO OEM MS DEALERS - AUTHORIZED (Requires a signed Dealer Contract) Price List Price List Type * 01 – GENERAL 02 – HYDRAULIC 03 – INDUSTRIAL Price List * PL1 PL2 PL3 PL4 PL5 PL6 PL7 PL8 PL9 PL10 PL11 PL12 Delivery and Payment Terms Incoterms * CPT - CARRIAGE PAID TO DAP - DELIVERED AT PLACE DDP - DELIVERED DUTY PAID EXW - Ex Works FCA - FREE CARRIER Payment terms * CASH IN ADVANCE 15 DAYS PAYMENT 30 DAYS PAYMENT Desired weekday for delivery from Dunlop Hiflex MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Sales Representatives Sales Representative * DK CASPER THULIN 2000000276 DK DENNIS ANDERSEN 2000000260 DK FREDERIK SKOV 2000000266 DK JIMMY SKOV 2000000170 DK NICOLAI SKOVBJERG 2000000120 DK NIELS MOLS 2000000258 DK MAGNUS BÆKTOFT 2000000160 DK CLAUS LANGE 2000000379 DK OLE ANDERSEN 2000000133 NO BERNT KVAM 2000000214 NO BJØRN BERGE 2000000173 NO BJØRN MOE 2000000138 NO BRITA STEINSLAND 2000000145 NO DAN WILHELMSEN 2000000152 NO EINAR ENGER 2000000174 NO EIRIK SOLVÅGSEIDE 2000000163 NO FREDRIK OVLAND 2000000142 NO JØRGEN HAUGSTVEDT 2000000213 NO KENT KRISTIANSEN 2000000165 NO LAILA MJÅTVEIT 2000000140 NO LEIF-TORE BOGEN 2000000137 NO RUNE JENSTAD 2000000222 NO THOMAS WANG 2000000155 NO TERJE BØRRE DAHL 2000000169 NO TOMMY NORDBØ 2000000263 NO TORSTEIN GRENDSTAD 2000000164 NO ØYVIND JAKOBSEN 2000000178 SE ANDREAS RENGREN 2000000052 SE ANTON PALAVRA 2000000171 SE ARMEND HAJRIZI 2000000073 SE EVELIN BADIC 2000000092 SE ELIN EDLING 2000000032 SE HENRIK SUND 2000000046 SE HÅKAN SCHÄDER 2000000202 SE JOHAN ERNEBRAND 2000000034 SE JOHAN PETTERSSON 2000000086 SE JÖRGEN PETTERSSON 2000000074 SE MARIA SUNDMAN 2000000051 SE MARKUS ENHÖRNING 2000000027 SE NICKLAS JANERFELT 2000000006 SE NIKLAS JOGÉR 2000000105 SE PER-ÅKE HAMMERIN 2000000025 SE EMILIA LUNDSTEDT 2000000085 SE PETER ANDERSSON 2000000078 SE PETER JARMIN 2000000010 SE PIERRE BRISARD 2000000053 SE RIKARD NOGÉN 2000000007 SE STEFAN NILSSON 2000000004 Service Center * DK 303L Kolding NO 331L Oslo NO 333L Tromsø NO 334L Bergen NO 335L Kristiansand NO 336L Ålesund NO 337L Harstad NO 338L Trondheim NO 342L Sarpsborg NO 339L Stavanger SE 361L Halmstad SE 362L Halmstad SE 379L Helsingborg SE 363L Borlänge SE 364L Göteborg SE 377L Ljungby SE 368L Malmö SE 369L Norrköping SE 371L Stockholm Järfälla SE 378L Stockholm Kungens Kurva SE 366L Umeå SE 374L Växjö SE 375L Östersund SE 376L Örebro Credit Control Credit Control Completed YES NO (To be performed prior to fill in the form) Other Comments Other comments
