<p> 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</p><p>REQUEST FOR MEMBERSHIP</p><p>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</p><p>LEGAL FORM DISTRIBUTION LEVEL (multiple choices possible)</p><p> 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 : ………………………………...</p><p>NUMBER OF EMPLOYEES REVENUE (last financial year)</p><p>OFFICE WORKERS : ………………… ……………………………………… MANUAL WORKERS :……………….. Company stamp OTHER :…………………….. TOTAL : ……………………...</p><p>Date Signature</p><p>………………………………….. ………………………………</p><p>Please note that subscriptions are only valid after approval of your membership request by the BOSTA Board of Directors. </p>