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REQUEST YOUR THIRD-PARTY PAYMENT AGREEMENT HERE

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You don't have a third-party payment system for our subscriptions yet, but you would like to use one?
Enter your company details and preferences below and we will send you a tailor-made third party payer agreement as soon as possible.

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COMPANY INFORMATION
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Enter the official name of the organization that wants to contribute to the cost price of the employee's subscription.

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Enter the address where the organization is located here. If the organization is located abroad, you cannot request a contract proposal online. Please contact us for this.

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Enter the VAT number of the organization. If your organization does not have a VAT number, you do not need to enter anything.

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Enter the enterprise number of the organization.

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Enter the name of the head office here, under which the organization that wants to intervene in the cost price of the subscription falls, without specifying the company form.

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Enter the address where the head office is located here.

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Enter the company number of the head office.

CONTRACT PROPOSAL INFORMATION
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Enter here for how many employees your organization estimates to intervene in the cost price of a subscription.

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Enter here for how many employees your organization estimates to intervene in the cost price of a subscription.

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Enter the total number of employees within your organization here.

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Select the date from which the contract can start.

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Enter the percentage that your organization wishes to contribute to the cost price of a subscription. The legal minimum contribution is 72%.

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Here you can indicate whether you as an organization wish to pay the administration costs of the MOBIB card for the entitled party. Also ensures a faster delivery time for subscriptions. Ideal when you intervene 100% on the subscription price.

CONTACT
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Enter the first name and name of the contact person within your organization who will follow up the contract.

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Enter the position of the contact person within your organization who will follow up the contract.

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Enter the telephone number of the contact person who will follow up the contract.

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Enter the e-mail address of the contact person who will follow up the contract.

CONTRACT SIGNATOR
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Write down the position of the person responsible who will sign the contract.

EMAIL FOR MONTHLY ALERTS
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Write down here the e-mail address to which the monthly alert list may be e-mailed.

BILLING INFORMATION
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Enter the name of the organization that will receive the invoice here

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Enter the billing address here

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Enter the name of the billing contact person here

THE DETAILS

OF YOUR REQUEST

Thank you

for your request

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The data you entered has been properly registered and you will receive your contract proposal as soon as possible. You can of course always personally contact one of our employees.

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Travel passes

The age of your employees automatically determines which travel pass they receive: a Buzzy Pazz (up to 24 years old) or an Omnipas (from 24 to 65 years old).

VALIDITY PERIOD

As a third party payer, you choose , for each employee, when a travel pass starts and for how long it will run (1, 3 or 12 months).

RECEPTION

The travel pass is sent directly to your employee's home address . The transfer form for the remaining amount also, if you do not intervene 100%.