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The permitted formats are: .png, .jpeg, .pdf, .doc and .docx with max size 2500 KB
For example: 0031123456789
For example: 3528-0888-8888-8888
For example: NL00BANK0123456789
For example: 21-01-1986
You wanted to charge:
The purchased balance in Euros:
OV-charging terminal:
Address:
Zip code:
City:
Transaction date:
Transaction time:
Comment:
Attachment:
Attachment extra:
Gender:
Name:
House number:
Phone number:
E-mail:
OV-chipcard number:
IBAN-Number:
Name cardholder:
Birthdate cardholder: