Home » Request for Letter of Access invoice - Only Representatives (OR)

Request for Letter of Access invoice - Only Representatives (OR)

This form should only be used by Only Representatives (OR) to purchase a Letter of Access on behalf of clients. If you are not an OR and are applying on your own behalf, please use this application form instead.

Please complete the form below to request an invoice for Letter(s) of Access for the chosen substances. If you have any queries please look at the detailed information on how to complete this application or contact us.

YOUR CONTACT DETAILS:

Please provide the contact details of the primary contact in case of any queries regarding this application. The email address you provide below will receive a confirmation email after submitting this application, with a summary of the information you have provided. It is also the email address to which the invoice will be emailed.
Name: *
E-mail:*
Enter E-mail again:*
Phone: *

LEGAL ENTITY DETAILS:

This information should relate to the Only Representative ('OR') legal entity. Separate applications must be made for each client and the client's name and UUID to which each application refers must be entered in the boxes at the end of this section.
Name of 'OR' Legal Entity: *
'OR' Company registration number: *
'OR' Registered office address: *
'OR' VAT Number (if registered):
Client Name:*
Client REACH UUID number:

SUBSTANCE REQUIRING A LETTER OF ACCESS:

Each application must relate to a single legal entity REACH registrant. Complete a separate form for each legal entity registrant. Please note that the > 1000 tonnes option in the menu below is not available for chemically-produced molybdenum disulfide.
	SUBSTANCE	TONNAGE BAND	Price (US$)

DETAILS TO APPEAR ON INVOICE:

Company Name, Department and Address to send invoice to:* Please re-enter full address here even if this is the same as the Legal Entity address above
For the attention of: *
Purchase Order / Budget Code:
Additional information to facilitate prompt payment: (will appear on invoice)
Any additional remarks: (will not appear on invoice)

Please do not enter anything in this box

Please click on the SUBMIT APPLICATION button below to send your application. After you click the button, a confirmation email will be sent to the email address you entered in 'Your Contact Details' above, with a summary of the information you have provided. You will then see a page which will confirm that your application has been submitted and where you can also download the relevant Letter of Access for you to complete.

If you have any queries please contact us.

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