MAH - New Registration · Customer Self-Service

Step 1
Step 2
Step 3
Step 4

To register an MAH with IMVO, please complete the details in each section of this form. An agreement between the MAH and IMVO must also be signed and details of this are in Step 2. Applications are processed within 1–2 business days. If we have any questions about the information provided, we will reach out to the primary contact for the MAH.

Details of MAH

Primary Contact for MAH

This will be the person who is responsible for the day to day communications with IMVO regarding this registration.

Primary Contact Name

Job Title

Primary Contact Email

Primary Contact Country Code

Primary Contact Phone Number

General

Name of MAH (full legal name)

Type of Company

(e.g. 'Limited Company')

Company Number (or equivalent)

Country in which MAH is established

Official Address

Note: The official address will be used in the MAH agreement (e.g. registered office address)

Official Address Line 1

Official Address Line 2

Official Address City/Town

Official Address County/State

Official Address Country

Official Address ZIP/Eircode/Postal Code

Is Business Address the same as Official Address?

NoYes

Business Address Line 1

Business Address Line 2

Business Address City/Town

Business Address County/State

Business Address Country

Business Address ZIP/Eircode/Postal Code