Project Request Form | MEDIC

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Project Request Form

On this page you can fill in your application for medical equipment and goods.

Request by

First name

Last name

Email

Phone

Street and number

Postal code, city and country

Short description of project request

Name and details of the hospital or institution requesting assistance

Address line 1

Address line 2

City

Region/state/province

Postal code

Country

E-mail address

Contact person hospital/Institution

List of requested equipment

Thank you for your request

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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