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.
Enter the official name of the organization that wants to contribute to the cost price of the employee's subscription.
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.
Enter the VAT number of the organization. If your organization does not have a VAT number, you do not need to enter anything.
Enter the enterprise number of the organization.
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.
Enter the address where the head office is located here.
Enter the company number of the head office.
Enter here for how many employees your organization estimates to intervene in the cost price of a subscription.
Enter the total number of employees within your organization here.
Select the date from which the contract can start.
Enter the percentage that your organization wishes to contribute to the cost price of a subscription. The legal minimum contribution is 72%.
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.
Enter the first name and name of the contact person within your organization who will follow up the contract.
Enter the position of the contact person within your organization who will follow up the contract.
Enter the telephone number of the contact person who will follow up the contract.
Enter the e-mail address of the contact person who will follow up the contract.
Write down the first name and name of the person responsible who will sign the contract.
Write down the position of the person responsible who will sign the contract.
Write down here the e-mail address to which the monthly alert list may be e-mailed.
Enter the name of the organization that will receive the invoice here
Enter the billing address here
Enter the name of the billing contact person here
OF YOUR REQUEST
for your request
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.
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).
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).
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%.
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