You're almost there!

Complete this form and within two business days you'll be charging more affordably – always a 10% discount at the fast-growing ALLSAFE-50five network and the rapidly expanding 50five fast chargers in The Netherlands!

Onderwerp *

Source *

Partner entity

Legal entity 50five *

Job type *

Language

Your first and last name *

Email adress *

Phone number *

Street name and house number *

Addition

Zip code *

City *

Company name

If it concerns a business application.

VAT number

If it concerns a business application.

What is the number on your charging case?

You will find this on your ALLSAFE-50five charging case:

Photo of your ALLSAFE 50five charging trickle *

Voeg hier de foto toe van uw ALLSAFE-50five laaddruppel inclusief het nummer beginnend met NL-LMS-...

Account holder name *

IBAN account number *

Public charging fees are invoiced and debited from this account. By providing your IBAN, you authorize direct debit.

Comments

Declaration of correctness of entered data *

I hereby declare that I have completed this form truthfully.

Data processing *

JYes, I agree to the use of personal data and its sharing with the billing party, Threeforce BV in accordance with the ALLSAFE-50five privacy policy and the terms and conditions for the ALLSAFE-50five charging trickle.

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