Bluecharge Card - BLUECHARGE

Private
Company

Client Information

Preferred Language

PT
EN

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Tem código de adesão Montepio Crédito?*

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Código de validação (promocode)*

Full name (Contract holder)*

Birth Date

Address*

Street Address Location ZIP / Postal Code

Phone / Mobile*

Email*

ID Number / Passport Number*

VAT Number*

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Cópia do Cartão de Cidadão ou Cartão de Identificação ou Passaporte ou Título de Residência do titular do contrato

Drop files here or

Max. file size: 64 MB.

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Permission*

I agree with the privacy policy.

Bluecharge will only store personal data and email addresses provided voluntarily by users and customers, or during its contact request, information or registration processes. Personal data submitted by customers will be processed Bluecharge's database. Bluecharge will only use the personal data of its customers for its normal commercial activity and relationship with customers, and may use it in direct marketing actions. Bluecharge will not sell or disclose any individual addresses or personal information to any other entity. The customer has the right to access his data and modify it in case of errors.

IBAN proof with the contract holder's name*

Max. file size: 64 MB.

The name of the contract holder must be identified on the IBAN proof

Nº of electric vehicles / PHEV*

Nº of cards*

Vehicle(s) Brand

Vehicle(s) Model

Year of Registration(s)

Schedule*

Plan*

Card Information

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Observations

Permission*

I agree with the privacy policy.

Bluecharge will only store personal data and email addresses provided voluntarily by users and customers, or during its contact request, information or registration processes. Personal data submitted by customers will be processed Bluecharge's database. Bluecharge will only use the personal data of its customers for its normal commercial activity and relationship with customers, and may use it in direct marketing actions. Bluecharge will not sell or disclose any individual addresses or personal information to any other entity. The customer has the right to access his data and modify it in case of errors.

General Data

Preferred Language

PT
EN

This field is hidden when viewing the form

Tem código de adesão Montepio Crédito*

This field is hidden when viewing the form

Código de validação (promocode)*

Social Designation (Contract Holder)*

Mailing Address*

Street Address Location ZIP / Postal Code

Phone / Mobile*

Email*

Tax ID Number*

Permanent Certificate*

IBAN*

IBAN proof with the contract holder's name*

Max. file size: 64 MB.

The name of the contract holder must be identified on the IBAN proof

Nº of electric vehicles / PHEV*

Number of Cards*

Vehicle(s) Brand

Vehicle(s) Model

Registration Year(s)

Schedule*

Plan*

Card Information

Company Name on the Card*

This information will also appear on the customer's physical card

This field is hidden when viewing the form

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Card Name*

Card Contact Email*

This e-mail serves as a contact for information on the end of vehicle loading.

Contact Details

Name*

Role*

Phone / Mobile*

Email*

Observations

Permission*

I have read and understood the General Conditions applicable to the Bluecharge Card

Comments

This field is for validation purposes and should be left unchanged.

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