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<div class="codesection" id="code-4959972">
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<h3 class="wFormTitle" data-testid="form-title" id="4959972-T">Pharmaceutical package</h3>
<form method="post" action="https://postnl.tfaforms.net/api_v2/rest/workflow/processor" class="hintsBelow labelsAbove" id="4959972" role="form">
<div class="htmlSection" id="tfa_67"><div class="htmlContent" id="tfa_67-HTML">Feel free to contact us</div></div>
<div class="oneField field-container-D    " id="tfa_68-D">
<label id="tfa_68-L" class="label preField " for="tfa_68">Subject</label><br><div class="inputWrapper"><select id="tfa_68" name="tfa_68" title="Subject" class=""><option value="">Please select...</option>
<option value="tfa_69" id="tfa_69" class="">Request a quote</option>
<option value="tfa_70" id="tfa_70" class="">Question / Remark</option></select></div>
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<div class="oneField field-container-D    " id="tfa_1-D">
<label id="tfa_1-L" class="label preField reqMark" for="tfa_1">First name</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1" name="tfa_1" value="" autocomplete="off" title="First name" class="validate-alphanum required"></div>
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<label id="tfa_26-L" class="label preField reqMark" for="tfa_26">Last name</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_26" name="tfa_26" value="" autocomplete="off" title="Last name" class="validate-alphanum required"></div>
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<label id="tfa_44-L" class="label preField reqMark" for="tfa_44">My question</label><br><div class="inputWrapper"><textarea aria-required="true" maxlength="250" id="tfa_44" name="tfa_44" title="My question" class="required"></textarea></div>
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<label id="tfa_49-L" class="label preField reqMark" for="tfa_49">Taal</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_49" name="tfa_49" value="en_BE" default="en_BE" maxlength="50" title="Taal" class="required"></div>
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<label id="tfa_59-L" class="label preField " for="tfa_59">E-mail tekst</label><br><div class="inputWrapper"><textarea maxlength="300" id="tfa_59" name="tfa_59" title="E-mail tekst" class=""></textarea></div>
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<label id="tfa_51-L" class="label preField reqMark" for="tfa_51">Categorie</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_51" name="tfa_51" value="contact opnemen" default="contact opnemen" maxlength="50" title="Categorie" class="required"></div>
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<label id="tfa_53-L" class="label preField reqMark" for="tfa_53">Webform Source</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_53" name="tfa_53" value="pharma contact be" default="pharma contact be" title="Webform Source" class="required"></div>
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  <p class="supportInfo" >
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<p>We are available by telephone from Monday to Friday 9.00 a.m. to 5.00 p.m.</p>

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<p>Do you wish to know the status of your parcel? Please use our<span>&nbsp;</span><a href="https://www.postnl.be/ontvangen/track-and-trace/" target="_self">Track &amp; Trace page.</a></p><p><strong>Parcels</strong><br/>+32 (0) 15298875<br/>We are available by telephone Monday to Friday from 9:00 a.m. to 5:00 p.m.</p>

Pharmaceutical package

Feel free to contact us

Pharmaceutical package

Contact us by phone