Community Farmer Pluktuin Proefdag Form

1. Abonnement details

2. Account gegevens

3. Afrekenen

Aantal personen:

Voor hoeveel personen?

Pluktuin proefdag momenten:

Kies op welke dag je mee komt doen met een pluktuin proefdag

Aantal personen

Timeslot ophalen

Totaal nu te betalen

Controleer je gegevens

Ga terug om aan te passen

Contactgegevens

E-mail:

Telefoon:

Voornaam:

Achternaam:

Factuuradres

Straat:

Huisnummer:

Toevoeging:

Postcode:

Woonplaats:

Opmerking

Opmerking:

Betaalmethode:

Betaal veilig met je IBAN rekeningnummer of Credit card via Stripe Checkout

Betaal met je bankpas via Ideal

Akkoord automatische incasso:

Hierbij geef ik akkoord om mijn abonnement per automatische incasso te incasseren.

Prijs:

€10

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above

Prijs:

€20

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above

Prijs:

€30

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above

Prijs:

€40

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above

Prijs:

€50

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above

Prijs:

€60

Voornaam: Voornaam is benodigd

Achternaam: Achternaam is benodigd

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Telefoon: Telefoon is not valid

Phoodbox address housenumber: Phoodbox address housenumber is not valid

Phoodbox delivery date: Phoodbox delivery date is not valid

Ik heb

User Comment: User Comment is not valid

Email:* Invalid Email

Wachtwoord:* ongeldig wachtwoord

Herhaal Wachtwoord:* Herhaal Wachtwoord Doesn't Match

Stripe Payments

Pay with your Credit Card via Stripe Checkout

Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.

Ik heb de gebruikersvoorwaarden en het privacy-beleid gelezen en ga hiermee akkoord.*

No val Please fix the errors above