Panagora

*Required fields

Create your account

Customer information

Party Type*

Canine Professionals

Organisation

First Name*

Last Name*

Shop Name*

BRN certificate

BRN Exempted Bodies (Government & Welfare Entities)

Legal Name on BRN

NIC*

Copy of NIC

BRN Number*

Format: png, jpg, jpeg, pdf*

BRN Certificate*

VAT certificate

Click here if the client is not VAT-registered (including government entities, welfare entities)

Are you VAT registered?*

Yes

VAT Number*

Format: png, jpg, jpeg, pdf*

VAT Certificate

Business Contact Information

Phone number* Fill at least 1 of these 2 phone number field

Mobile number* Fill at least 1 of these 2 phone number field

Email address

Using details as order information*

Yes

Contact details for orders

First Name*

Last Name*

Phone number* Fill at least 1 of these 2 phone number field

Mobile number* Fill at least 1 of these 2 phone number field

Ordering Email Address*

Delivery Address

Street*

City*

Country*

Customer specifications

Business type*

Sales group

Sub-section*

Segment*

Product Category Request*

FRAIS – Fruits & Légumes

FRAIS – Salades & Charcuterie de Volaille

FRAIS – Viande

FRAIS – Volaille

FRAIS – Yaourt, Beurre & Fromages

SECS – Epicerie, Snacking, Boissons

SURGELÉS - Mer, Viande, Volailles, Légumes, Desserts

VEG

Business Opening Time(s)*

Monday

Opening time

Tuesday

Opening time

Wednesday

Opening time

Between

And

Thursday

Opening time

Between

And

Friday

Opening time

Between

And

Saturday

Opening time

Between

And

Sunday

Opening time

Between

And

Preferred delivery slot 1*

Between

And

Delivery Message

Comments

I have read and accept all the terms and conditions

Create your account

Customer information

BRN certificate

VAT certificate

Business Contact Information

Contact details for orders

Delivery Address

Customer specifications

Opening time

Opening time

Opening time

Opening time

Opening time

Opening time

Opening time

Preferred delivery slot 1*

Preferred delivery slot 2