Company Directory Form - A3P - Pharmaceutical & Biotechnology Industry

Information
Title*
- Mr.
- Mrs.
Name*
First name Name
Company*
Function*
E-mail*
Phone number*
Company presentation
Address*
Address City ZIP / Postal Code Country
Contact e-mail*
Phone number*
Website*
Please attach a logo, a text presenting your company and other elements such as images, videos, pdfs... (you can attach several elements):
Drop files here or
Accepted file types: jpg, png, pdf, xls, xlsx, docx, odt.
Invoicing
Company*
Address*
Address City ZIP / Postal code Country
Intracommunity VAT number :
Additional billing information :

Payment information
Payment method*
- Credit / Debit card
- Bank transfert
Paiement par carte bancaire*
The Stripe Card field cannot work when the Payment Collection Method is set to Stripe Payment Form (Stripe Checkout).
Purchase order number
Total to be paid (incl. Tax)
0,00 €
General terms and conditions
General conditions for A3P forms*
- The information collected on this form is recorded in a computerised file by the A3P Association. This information is intended for the management of the A3P database, for invoicing, as well as for the marketing and sales department. This data will not be disclosed to third parties. In accordance with the French Data Protection Act, the "Règlement Général sur la Protection des Données" (RGPD) and our Privacy Policy (https://a3p.org/a3p-privacy-policy/), you may exercise your right to access, rectify and delete this data. By submitting this form you acknowledge that you have accepted these terms and conditions and our Privacy Policy. Translated with www.DeepL.com/Translator (free version)
Email
This field is for validation purposes and should be left unchanged.

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