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Application for participation

You are a provider of social App and would like to participate to the Offer, fill in the form hereunder. 

Only 1 App per application form.

All fields are mandatory except those where "optional" is mentioned.

Company
{{errorMessages.companyname.required}} {{errorMessages.companyname.pattern}} {{errorMessages.companyname}}
{{errorMessages.vat.required}} {{errorMessages.vat.pattern}} {{errorMessages.vat}}
{{errorMessages.street.required}} {{errorMessages.street.pattern}} {{errorMessages.street}}
{{errorMessages.number.required}} {{errorMessages.number.pattern}} {{errorMessages.number}}
{{errorMessages.box.required}} {{errorMessages.box.pattern}} {{errorMessages.box}}
{{errorMessages.zipcode.required}} {{errorMessages.zipcode.pattern}} {{errorMessages.zipcode}}
{{errorMessages.city.required}} {{errorMessages.city.pattern}} {{errorMessages.city}}
Contact
Commercial contact person
{{errorMessages.firstname.required}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname}}
{{errorMessages.lasttname.required}} {{errorMessages.lasttname.pattern}} {{errorMessages.lasttname}}
{{errorMessages.email.required}} {{errorMessages.email.pattern}} {{errorMessages.email}}
eg +32 {{errorMessages.countrycode.required}} {{errorMessages.countrycode.pattern}} {{errorMessages.countrycode}}
{{errorMessages.telefoon.required}} {{errorMessages.telefoon.pattern}} {{errorMessages.telefoon}}
Technical contact person
{{errorMessages.same.required}} {{errorMessages.same.pattern}}
{{errorMessages.firstname2.required}} {{errorMessages.firstname2.pattern}} {{errorMessages.firstname2}}
{{errorMessages.name2.required}} {{errorMessages.name2.pattern}} {{errorMessages.name2}}
{{errorMessages.emailtech.required}} {{errorMessages.emailtech.pattern}} {{errorMessages.emailtech}}
{{errorMessages.countrycodetech.required}} {{errorMessages.countrycodetech.pattern}} {{errorMessages.countrycodetech}}
{{errorMessages.telefoontech.required}} {{errorMessages.telefoontech.pattern}} {{errorMessages.telefoontech}}
Info about the App
{{errorMessages.appname.required}} {{errorMessages.appname.pattern}} {{errorMessages.appname}}
{{errorMessages.description.required}} {{errorMessages.description.pattern}} {{errorMessages.description}}
{{errorMessages.appstore.required}} {{errorMessages.appstore.pattern}} {{errorMessages.appstore}}
{{errorMessages.playstore.required}} {{errorMessages.playstore.pattern}} {{errorMessages.playstore}}
Technical info about the App
{{errorMessages.p2pprotocol.required}} {{errorMessages.p2pprotocol.pattern}} {{errorMessages.p2pprotocol}}
{{errorMessages.ip.required}} {{errorMessages.ip.pattern}} {{errorMessages.ip}}
{{errorMessages.domain.required}} {{errorMessages.domain.pattern}}
{{errorMessages.sni.required}} {{errorMessages.sni.pattern}} {{errorMessages.sni}}
{{errorMessages.protocols.required}} {{errorMessages.protocols.pattern}} {{errorMessages.protocols}}
{{errorMessages.url.required}} {{errorMessages.url.pattern}} {{errorMessages.url}}
{{errorMessages.portnumbers.required}} {{errorMessages.portnumbers.pattern}} {{errorMessages.portnumbers}}
General Terms & Conditions

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