| Faxen naar
Barmaton InterNETional B.V. Afdeling Domein-registraties-particulieren Faxnr: 040-2070232 of per post: Postbus 314 5550AH Valkenswaard |
Incassoformulier Particuliere domeinnaam-redirection.
| Domeinnaam: | ........................................................................................nl |
| Homepage van uw website: | ........................................................................................ |
| Uw huidige e-mailadres : | ........................................................................................ |
| Naam: | ........................................................................................ |
| Geboortedatum: | ........................................................................................ |
| Geboorteplaats: | ........................................................................................ |
| Rekeningnummer: Postbank/ Bank * | ........................................................................................ |
| Adres (geen postbus): | ........................................................................................ |
| Postcode + Plaatsnaam: | ........................................................................................ |
| Telefoon: | ........................................................................................ |
| Datum: | ........................................................................................ |
| Handtekening: | ........................................................................................ |
*) Doorhalen wat niet van toepassing is