Aanmelding abonnement (koop) [EN]

Subscription *

Subscription 1st year € 100,- after that € 120,- per year

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E-Mail *

Postalcode and housenr. *

Street *

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Payment options

Payment *

in3pay directly online

Bankaccountnumber *

BIC/Swift code

You have chosen to pay via iDeal. We are happy to process this for you. At the same time, we request that you issue a direct debit authorization for the payment of any subsequent subscription periods.

Je hebt gekozen om via automatische incasso te betalen. Dit verwerken we graag voor je. We verzoeken je om hiervoor een machtiging af te geven.

Je ontvangt van ons na inzending van dit formulier een digitale factuur in je mailbox.

I authorize Roxelane Care B.V. to automatically debit the subscription fee from my account. The creditor ID of Roxelane Care B.V. is NL47ZZZ744227580001.

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Yes, I authorize Roxelane Care BV

Terms and conditions

Please read our general terms and our user agreement

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I have read the general terms and agree to them

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I have read the user agreement and I agree with it

Fields indicated with * are mandatory