Belgian Office and Stationery Trade Association ASBL VZW

Belgian Office and Stationery Trade Association ASBL VZW Bruyndonckxstraat 31/B 1 – 1780 Wemmel - Tel +32/2 460 62 12 - Fax +32/15 63 03 92 RPM/RPR Bruxelles/Brussel – BTW/TVA BE 425.419.729 - [email protected] - www.bosta.org

REQUEST FOR MEMBERSHIP

COMPANY …………………………………………… Founded in ..………….……………………………... Address …………………………………………… Postal code……… City….. …………………..…..…… Name (person responsible) ………………………………. First name ………….………………………...... Title……..……………………… ……... Website…………………………………………………………...... Phone ……………………………Fax : …………………………...Mobile : …….…………………………… E-Mail …………………………………………..….. Company registration n°/VAT………………….………. Bank account : IBAN …………………………….…………BIC ………..………… language : NL/FR/ENG

LEGAL FORM DISTRIBUTION LEVEL (multiple choices possible)

 NATURAL PERSON  MANUFACTURER OR BRANCH OF A FOREIGN FACTORY  PLC  IMPORTER OR FOREIGN FACTORY AGENT  LTD  WHOLESALE  ………………..  STATIONER  SUPPLIER  MASS DISTRIBUTION  PURCHASING CONSORTIUM  SPECIALIZED STORE  SPECIALITY : ………………………………...

NUMBER OF EMPLOYEES REVENUE (last financial year)

OFFICE WORKERS : ………………… ……………………………………… MANUAL WORKERS :……………….. Company stamp OTHER :…………………….. TOTAL : ……………………...

Date Signature

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Please note that subscriptions are only valid after approval of your membership request by the BOSTA Board of Directors.