Fillable SEPA-Lastschriftmandat

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SEPA-Lastschriftmandat

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Gläubiger-Identifikationsnummer PL43ZZZ9581468984
Mandatsreferenz WIRD SEPARAT MITGETEILT
SEPA-Lastschriftmandat
Ich ermächtige die GetResponse Sp. z o.o., Zahlungen von meinem Konto mittels Lastschrift
einzuziehen. Zugleich weise ich mein Kreditinstitut an, die von
der
GetResponse Sp. z o.o. auf mein Konto gezogenen Lastschriften einzulösen.
Hinweis: Ich kann innerhalb von acht Wochen, beginnend mit dem
Belastungsdatum, die Erstattung des belasteten Betrages verlangen.
Es gelten dabei die mit meinem Kreditinstitut vereinbarten Bedingungen.
Vorname und Name (Kontoinhaber)
Straße und Hausnummer
Postleitzahl und Ort
Kreditinstitut (Name und BIC)
D E
IBAN
Datum, Ort und Unterschrift
GetResponse Sp. z o.o., ul. Arkonska 6, A3, 80-387 Gdansk, Polen
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SEPA-Lastschriftmandat

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Completed 17 April 2020

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