Provide SEPA Direct Debit Authorization - Welkom bij Drentsche Patrijshonden Club Nederland

Authorization form

With this form you can convert your payments of contribution and / or reading accounts to SEPA Direct Debit mandate. Please complete the fields below as completely as possible. After you have filled in all the fields below, you can send the message and you will receive an email with the pre-filled authorization form. You can print it and sign it and send it to us or send us a scan of the signature form.

Name*
Initials Last
Gender*
- Male
- Female
Date of birth
Date Format: DD dash MM dash YYYY

dd-mm-yyyy
Address*
Street Address City ZIP / Postal Code Country
Phone number*
E-mail Address*
Account Number (IBAN)*
BIC Code (mandatory for foreign account)*
Name of account holder*
Initials Last