Project Request Form | MEDIC

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Project Request Form

On the next pages you can fill in your application for medical equipment and goods.

Contact information

Enduser medical equipment (person, hospital, other)

Address

Country

Requesting party for help (Foundation, Hospital, Other)

Street + house number

Postal Code

Place

Country

Phone

Fax

E-mail

Confirm E-mail

Contact:

phone: +31 55 355 8358

fax: +31 55 355 8338

e-mail: info@medic.nl

Address:

Medic Foundation

Johannes Bosboomstraat 29

7312 LM Apeldoorn

The Netherlands

Opening hours:

Tuesday- and Thursday mornings

09.00 - 12.00 hours

Bank:

IBAN: NL78INGB0653315538 BIC: INGBNL2A

Chamber of commerce:

41 03 92 67

© 2021 Stichting Medic

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