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State
Website
Facebook
Instgram
Email
Shop phone number
Mobile phone
Private Number
DE Number
Company Registration
We ask you to provide a copy of your registration in the trade register. We ask you to indicate how you will do this:
If you only have the company registration on paper, fax us: 0800 629 73 70

COLLECTION AUTHORIZATION

I / we hereby authorize you revocably to collect the payments made by me / us by direct debit (reason for obligation, possible amount limit, exact name of the account holding bank). If my / our account does not have sufficient funds, there is no obligation for the bank holding the account to repay it. Partial repayment does not take place by direct debit. In case of simultaneous withdrawal of the existing direct debit mandate for the same reason for the obligation at the institution.
Bank*
IBAN*
Place
Date
03-03-2021
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