POLE AVENIA

1- Company information

Company name

Website

Logo (Format .jpg or .png)

NAF code

Legal status

Company registration number

Intracommunity VAT number (if concerned)

Workforce

Company type

Do you belong to a corporation ? If yes, which one ?

Markets several possible options

Category one possible choice

Activities

My company is in France ? Remember to uncheck this box if the billing address is outside France and you are not subject to VAT. As a reminder, as companies domiciled outside France do not receive any financial support from French public institutions, higher subscription fees apply (double the rate applied to companies domiciled in France).

Address

Address(Number and street)

Additional address information

Postal Box

Zip code

City

Region

Country

Billing address if different (optional)
Please complete if different from the above. This address will appear on your invoice.

Company name
Mentionnez le nom que vous souhaitez voir figurer sur l’entête de votre facture

Full billing address
Mentionnez l'adresse que vous souhaitez voir figurer sur l'entête de votre facture

2- Company representative

Director (first name)

Director (last name)

Director (function)

3- Referent and representative at the Avenia GA

First name

Last name

Position

Phone

4- Information and payment

J'ai un accord de partenariat

Billing point of contact

First name

Last name

Phone

Payment method

Would you like to include an order number on your invoice *
for accounting purposes? NonOui

5- EartH₂ program

Participate to eartH₂ program

Your subscription to POLE AVENIA

Address

Billing address if different (optional) Please complete if different from the above. This address will appear on your invoice.

Billing address if different (optional)
Please complete if different from the above. This address will appear on your invoice.