Are you a former Shell Recharge customer? 50five charging fob needed?

Please fill in the form below.

Form.

Onderwerp *

Source *

Partner entity *

Legal entity 50five *

Job type *

Your first and last name *

Email address *

Phone number *

Street name and house number *

Addition

Postal code *

City *

Company name

If you use this charging card/fob at your workplace.

Do you already have a 50five charging card/fob? *

Yes

No

Is there an active 50five charging station at your address? *

Yes

No

I don't know

If there is an active 50five charging station at your address, the requested charging card/fob will automatically be linked to the account connected to the charging station.

Which situation applies to you regarding your charging card? *

I use the charging card only for basic charging, without extra services, and do not pay a monthly subscription fee.

I use the charging card with additional services, such as home charging reimbursement or charging on the public network, and pay a monthly subscription fee of £3.00 incl. VAT.

Please note: the 50five charging card/fob has a one-time fee of £9.00 incl. VAT (charging card/fob and shipping).

Agreement to application costs *

I agree to the mandatory one-time costs of £9.00 incl. VAT for the charging card and shipping.

If I select the optional monthly charging card subscription for home and public charging, I also agree to the subscription fee of £3.00 incl. VAT per month. After submission, the request will be processed and the applicable amount will be included on the next subscription invoice.

Remarks

Declaration of accuracy of the provided information *

I hereby declare that I have completed this form truthfully.

Data processing *

Yes, I consent to the use of personal data and its sharing with the billing party, Threeforce BV, in accordance with the 50five privacy policy and the terms and conditions.

Submit