Aanvragen

Laadpas(sen) aanvragen

Vul hier uw gegevens in.

1Uw bestelling

2Uw gegevens

3Bestelling

Bestelcode
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Lidnummer
Hidden
Vereniging
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DatumvoorZOHOdmy LPD
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Datum dateformat dmy
DD dash MM dash JJJJ
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website_gratis_pas
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Leverancier ZOHO
Hidden
Type product ZOHO
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Leadstatus ZOHO
Welke passen wilt u bestellen?*
- Laadpas BP
- Total Energies
- Shell
Deze laadpas kunt u aanvragen via deze link op de website van Shell.
Aantal*
BP Laadpas*
Prijs:
per maand
Naast laden kunt u ook deze pas gebruiken als tankpas met tot 12 cent korting per liter op Diesel/Benzine/LPG bij BP, Total, Argos, Greenpoint, Texaco en Esso (korting incl. BTW t.o.v. landelijk adviesprijs).
BP Laadpas
Geldigheid kaart 1*
Soort brandstof kaart 1*
Kenmerk of kenteken kaart 1
Voorkeur pincode (optioneel)
BP Laadpas 2
Geldigheid kaart 2*
Soort brandstof kaart 2*
Kenmerk / kenteken
Voorkeur pincode (optioneel)
BP Laadpas 3
Geldigheid kaart 3*
Soort brandstof kaart 3*
Kenmerk / kenteken
Voorkeur pincode (optioneel)
Aantal*
Esso brandstofpas*
Prijs:
per jaar
Geldigheid kaart 1*
Soort brandstof*
Kenmerk / kenteken
Hidden
Geldigheid kaart 2*
Soort brandstof*
Kenmerk / kenteken
Geldigheid kaart 3*
Soort brandstof*
Kenmerk / kenteken
Aantal*
Total Energies pas*
Prijs:
per maand
Geldigheid*
Soort brandstof*
Kenmerk / kenteken
Voorkeur pincode (optioneel)
Geldigheid*
Soort brandstof*
Kenmerk / kenteken
Voorkeur pincode (optioneel)
Geldigheid*
Soort brandstof*
Kenmerk / kenteken
Voorkeur pincode (optioneel)
Subtotaal
€ 0,00
BTW
€ 0,00
Totaal incl. BTW
€ 0,00

Snel invullen
Vul uw postcode en lidnummer in. Uw gegevens worden automatisch ingevuld in het formulier

Er zijn 1 of meerdere velden niet (correct) ingevuld

Vereniging

Lidnummer U kunt uw lidnummer vinden op de contributienota of op het adreslabel van Nieuwe Oogst. Of laat dit veld leeg en vul uw gegevens handmatig in.

Postcode Van uw lidmaatschapsadres

Uw gegevens zijn gevonden.

Uw gegevens kunnen momenteel niet worden gevonden. Geen zorgen, u kunt het formulier ook handmatig invullen (of bel naar 088 888 6777 voor uw lidnummer)
Hidden
Wiersma Klant nummer*

U heeft aangegeven dat u geen lid bent van LTO Noord, ZLTO of LLTB. Indien u een reeds een klantnummer heeft bij Wiersma Olie en Techniek kunt u doorgaan met bestellen. Heeft u nog geen klantnummer? Neem dan telefonisch contact op met Wiersma tel: 0513 – 87 00 27
Uw gegevens
Voornaam/-letters*
Tussenvoegsel
Achternaam*
Geslacht
- Man
- Vrouw
Bedrijfsnaam

Laat dit veld leeg als u particulier bent of geen bedrijfsnaam heeft.
Adresgegevens
Straat*
Huisnr*
toevoeging
Postcode*
Woonplaats*
Factuuradres
Factuuradres
- Het factuuradres wijkt af van het bovenstaand adres
Hidden
Straat*
Huisnr*
toevoeging
Postcode*
Woonplaats*
Leveringsadres
Leveringsadres
- Het leveringsadres wijkt af van het bovenstaand adres
Hidden
Straat*
Huisnummer*
toevoeging
Postcode*
Woonplaats*
Contact
Emailadres*
- ik wil graag de ledenvoordeel-nieuwsbrief ontvangen
Telefoonnr*
Mobiel

Product	Qty	Unit Price	Price
Esso brandstofpas	1	€ 8,95	€ 8,95
		Subtotal	€ 8,95
		Total	€ 8,95

@(prijs per maand)

Automatische incasso
Iban*
ten name van*
Door op verzenden te klikken gaat u akkoord met automatische incasso en de leveringsvoorwaarden van LTO Ledenvoordeel.
Door op 'verzenden' te klikken, bevestig ik dat ik het Privacy Statement van LTO Ledenvoordeel heb gelezen en hiermee akkoord ga.
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zoho opmerkingen
Laadpas <table class="gpecf-order-summary" cellspacing="0" width="100%" style="margin: 0;border: 1px solid #dfdfdf;border-right: none"> <thead> <tr> <th scope="col" style="border-right: 1px solid #dfdfdf;text-align: left;padding: 8px 10px;font-weight: normal;font-size: var( --gf-font-size-secondary, 14px );background-color: #f4f4f4;width: 50%">Product</th> <th scope="col" style="border-right: 1px solid #dfdfdf;text-align: center;padding: 8px 10px;font-weight: normal;font-size: var( --gf-font-size-secondary, 14px );background-color: #f4f4f4">Qty</th> <th scope="col" style="border-right: 1px solid #dfdfdf;text-align: right;padding: 8px 10px;font-weight: normal;font-size: var( --gf-font-size-secondary, 14px );background-color: #f4f4f4">Unit Price</th> <th scope="col" style="border-right: 1px solid #dfdfdf;text-align: right;padding: 8px 10px;font-weight: normal;font-size: var( --gf-font-size-secondary, 14px );background-color: #f4f4f4">Price</th> </tr> </thead> <tbody> <tr> <td style="border-right: 1px solid #dfdfdf;vertical-align: top;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );width: 50%"> <div style="font-weight: bold;color: #bf461e;font-size: var( --gf-font-size-tertiary, 13px );margin-bottom: 5px"> Esso brandstofpas </div> </td> <td style="border-right: 1px solid #dfdfdf;vertical-align: top;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );text-align: center">1</td> <td style="border-right: 1px solid #dfdfdf;vertical-align: top;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );text-align: right">€ 8,95</td> <td style="border-right: 1px solid #dfdfdf;vertical-align: top;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );text-align: right">€ 8,95</td> </tr> </tbody> <tfoot> <tr> <td style="border-right: 1px solid #dfdfdf;vertical-align: middle;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );border-top: 1px solid #dfdfdf;background-color: #f4f4f4;background: repeating-linear-gradient( 45deg, #f4f4f4, #f4f4f4 3px, #fafafa 3px, #fafafa 6px )" colspan="2" rowspan="2"></td> <td style="border-right: 1px solid #dfdfdf;vertical-align: middle;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );border-top: 1px solid #dfdfdf;font-weight: bold;background-color: #f4f4f4;text-align: right">Subtotal</td> <td style="border-right: 1px solid #dfdfdf;vertical-align: middle;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );border-top: 1px solid #dfdfdf;font-weight: bold;background-color: #f4f4f4;text-align: right">€ 8,95</td> </tr> <tr> <td style="border-right: 1px solid #dfdfdf;vertical-align: middle;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );border-top: 1px solid #dfdfdf;font-weight: bold;background-color: #EAF2FA;text-align: right">Total</td> <td style="border-right: 1px solid #dfdfdf;vertical-align: middle;padding: 8px 10px;font-size: var( --gf-font-size-tertiary, 13px );border-top: 1px solid #dfdfdf;font-weight: bold;background-color: #EAF2FA;text-align: right">€ 8,95</td> </tr> </tfoot> </table>

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