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IDA Foundation Customer Registration

To become an IDA Foundation customer and be able to request our products via our web catalogue or ARV request form you have to register by using the below form.

IDA Foundation stands for quality products and quality service.
The quality of our products is assured through our integral QA/QC system, but in order to serve you well we need to know you well. That is why we ask you to take a few minutes of your time to fill in this form.
Fields marked with * are obligatory.

regform1

Name of organisation*

Department

Address*

Postal code*

City*

Country*

POBox

Number

Postal code

City

regform2

Phone*

Fax*

E-mail address*

Website

Contact person 1

Contact person 1*

First name*

Last name*

Position*

Phone

E-mail address

Preferred language of communication*

Contact person 2

First name

Last name

Position

Phone

E-mail address

Preferred language of communication

Organisation

Type of organisation*

Scope of organisation*

Organisation size*

Main activity of your organisation:*

Development aid

Emergency relief

Ministry

Central Medical Store

Wholesale, distribution

Pharmacy, dispensary

Hospital / clinic

University / institute

Other..

if Other, please specify..*

receive

Do you want to receive regular product / price information from IDA Foundation?*

Yes, both electronic and hard copy

Yes, hard copy only

Yes, electronic copy only

Additional information