JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Flowerpot
You can get your Esperia Flowerpot for only €3,-
For non-members the flowerpot will cost €4,-
Show off our association and your most beautiful plants at the same time!
The deadline to order one is 25-04-2021, so order one now!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name + Surname
*
Your answer
I would like to buy one Esperia Flowerpot for a price of €3,- if I'm a member and €4,- if I'm a non-member
*
Yes! - I am a member of Esperia
Yes! - I am not a member of Esperia
Would you like to pick it up in Groningen (address near the Stadspark will be shared at a later time) for free or would you like to have it delivered to your house in the city of Groningen (this will cost €1,-).
*
I would like to pick it up (a date for pick-up will be discussed with you later!)
I would like to have it delivered to my house in Groningen (this will cost an additional €1,-)
If you are having your merchandise delivered, what is your address? (*the merchanise can only be delivered in the city of Groningen)
Your answer
Bank account number (IBAN)
*
Your answer
Initials + last name bank account holder
*
Your answer
I allow Esperia to withdraw the fee (€7,50-) from my bank account.
*
I understand and agree with this condition
If you change your mind about ordering the GK package, send us an email via
bestuur@svesperia.nl
before 19-05-2021 at 23:59h. If you cancel after the deadline, the amount of money will be withdrawn from your bank account.
*
I understand and agree with this condition
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of University of Groningen.
Report Abuse
Forms
