Automatische incasso


With this form you can authorize Impressed to automatic collection of the regular costs of the services you have requested.

 

 


General contract information
Company Name: *
Person Name: *
Address: *
Postcode and City: *
Email: *
Telephone: *
Fax:

Bank information
Bank Number: *

I authorize Impressed to automatically debit the amount owed to the regular services you have requested. This debit will take effect with the signing of this form signed by the competent.


signature
Company Name: *
Person Name: *
City: *
Date: *
How do you invoice? * digital
 by post
For approval: * Yes:

This direct debit form is part of the agreement (s) between you as a customer en Impressed. By signing certify that:
- He / she is authorized the agreement on the services requested on behalf of the company / person box immediately
* This is a required field
 
Please enter the code shown above in the field next to it.
This is to prevent automated registrations.