Wholesale Application

Mana Minds SIA
Registration number: 40203111438
VAT No.: LV40203111438
Talivalza iela 21 – 38, Riga LV-1006 Latvia

Wholesale Application Form

Company Information

Business Type

Company Address

Zip Code

Country

Telephone/ Skype I.D

Customer Email

Website

Legal Information

Please note: you must include scanned or photocopied documents to confirm these registrations.

Company Registrations No

Date of incorporation

VAT-Tax Registration

Country of registration

Bank Details

Bank Name

Bank Address

Account / Beneficiary Name

Currency

Bank Tel.

Account No

IBAN

Sort Code

SWIFT

For U.S.A. Account Only (Required)

ABA/ Wire Routing No.

ACH Routing No.

PURCHASING MANAGER (Person in Charge)

Name

Telephone

Skype I.D

ACCOUNTS PAYABLE (Finance)

Name

Telephone

Skype I.D

I confirm that I have read, understood and agreed to the Terms and Conditions

For and on behalf

Signature (Above printed name)

Position

Date

Company Registration Certificate

Wholesale Application - Manaminds