New Client (no pets) Registration
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number (please include the country code)
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May we contact you via WhatsApp
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Yes
No
Is there another method of contact that we should use for you (ie Facebook messenger)?
By default, De Fiets- en Hondenstop will contact you via email to the address you provided above and will use your phone number to call you, leave a voicemail, and/or send you text and/or WhatsApp messages unless otherwise requested. We will also add your email address to our newsletter mailing list automatically. Please note that in cases of emergency, we may override your contact requests in an attempt to contact you.
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I agree
I don't agree
Your Billing Address
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Country
Street Address
City
State / Province
Postal Code
Address where services will take place (if applicable) - Please indicate 'De Fiets- en Hondenstop' if services will take place at our location and 'online' if services are digital only.
Country
Street Address
City
State / Province
Postal Code
Emergency Contact Information
Please choose an emergency contact that we can reach if you are not available.
Emergency Contact's name, phone number, email, and city of residence
*
Billing Information
By default, De Fiets- en Hondenstop will invoice NL and EU clients; invoice requests will be made viaemail and will include options to pay via iDEAL, PayPal, or through direct transfer via IBAN number.Clients based out of the US will be invoiced via email with a request to pay via PayPal, in which credit ordebit card payments are possible as well. Where applicable, please indicate the sliding scale rate thatyou will be paying for our services. Invoices are based on services that have already taken place in thetime between the last invoice date and the current one and are sent at the end of each month.
Please indicate which of the following is applicable to you
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I am a NL client
I am an EU client
I am a US client
I am a client outside of the NL/EU/or US
Please Sign to ensure the information you've provided is accurate to the best of your knowledge
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Please type your full name
*
Your location
*
Today's date
*
Submit
Submit
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