Partner area
Master data sheet for the registration of new customers

Master data sheet
for the registration of new customers

please fill out the following form completely.

- Step 1 of 7

Branch office

Company name *

Street & No. *

Postcode *

City *

State

Telephone number *

Fax no.

E-mail *

Website *

Paedacoustics store

Contact person for paedacoustics

Purchasing group

Name purchasing group

Address for confidential data

Management *

Street & House no. *

Postcode *

City *

Telephone number *

Fax no.

E-mail *

Invoice address

Note: If you have "centralised invoicing" via your purchasing group, this will of course be taken into account when invoicing. If this is not the case, all invoices will be sent exclusively to the invoice address stated here by e-mail.

Company name (invoice address)

Street & No.

Postcode

City

State

Telephone number

Fax no.

E-mail *

Website

VAT ID *

Request direct debit mandate

Only possible if there is no central regulation of a purchasing group.

Delivery of invoices

You will receive invoices by e-mail as standard. Please contact us if you would like to make any changes.

Rights of use

At www.hoerluchs.com you will find the data protection guidelines and general terms and conditions of Hörluchs Hearing GmbH & Co. KG.

We have read and agree to the current privacy policy *

We have read and agree to the current terms and conditions *

Service

Note: With our newsletter we inform you about important changes to our products, e.g. price adjustments or technical innovations.

We would like to receive the Hörluchs® newsletter *

We agree to the publication as partner dealer on Hoerluchs.com *

We would like to receive an online training on the products of Hörluchs®. *

You can register directly for a free training here: Free get-to-know training (online seminar). You can also forward this link to your other shops. They can also use it to register for participation.

Further branches

Please select whether and how many additional shops you would like to register.

Would you like to note further shops? *

Number of further shops

Additional shop 1:

Please enter the data of the additional shop here.

Additional shop 1 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

E-Mail

Website

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 2:

Please enter the data of the additional shop here.

Additional shop 2 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

E-mail

Website

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 3:

Please enter the data of the additional shop here.

Additional shop 3 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

E-mail

Website

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 4:

Please enter the data of the additional shop here.

Additional shop 4 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

E-mail

Website

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 5:

Please enter the data of the additional shop here.

Additional shop 5 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

E-Mail

Website

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 6:

Please enter the data of the additional shop here.

Additional shop 6 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

Website

E-mail

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 7:

Please enter the data of the additional shop here.

Additional shop 7 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

Website

E-mail

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 8:

Please enter the data of the additional shop here.

Additional shop 8 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

Website

E-mail

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 9:

Please enter the data of the additional shop here.

Additional shop 9 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

Website

E-mail

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Additional shop 10:

Please enter the data of the additional shop here.

Additional shop 10 (company name)

Street & House no.

Postcode

City

State

Telephone number

Fax no.

Website

E-mail

Additional

Delivery address = Billing address
Invoice address as on sheet 1
Paedacoustics branch

Contact person for paedacoustic

Date & Name

Date *

First name & surname *

Deutsche Version

^{3D TEC}	^{4 Days}
^{3D SOFT SILICONE}	^{4 Days}
^{3D THERMOtec®}	^{4 Days}
^{3D TITANIUM}	^{7 Days}
^{Custom In-Ears}	^{10 Days}

^{Hearing Protection}	^{5 Days}
^{Hearing Protection THERMOtec®}	^{4 Days}
^{Active Hearing Protection}	^{10 Days}
^{ICP® Hearing Systems}	^{10 Days}
^{ICP® Hearing Systems with THERMOtec®}	^{10 Days}

Master data sheet
for the registration of new customers

Branch office

Purchasing group

Address for confidential data

Invoice address

Delivery of invoices

Rights of use

Service

Further branches

Additional shop 1:

Additional shop 2:

Additional shop 3:

Additional shop 4:

Additional shop 5:

Additional shop 6:

Additional shop 7:

Additional shop 8:

Additional shop 9:

Additional shop 10:

Date & Name

Do you have any questions?

Current production time

Master data sheet for the registration of new customers

Branch office

Purchasing group

Address for confidential data

Invoice address

Delivery of invoices

Rights of use

Service

Further branches

Additional shop 1:

Additional shop 2:

Additional shop 3:

Additional shop 4:

Additional shop 5:

Additional shop 6:

Additional shop 7:

Additional shop 8:

Additional shop 9:

Additional shop 10:

Date & Name

Do you have any questions?

Current production time

Master data sheet
for the registration of new customers