Studentenfiets / Student bike
Email address *
Voornamen / First name *
Your answer
Naam / Last name *
Your answer
Adres / Address *
Your answer
PXL- UCLL studentennummer / Student number *
Your answer
Startdatum / Start date *
MM
/
DD
/
YYYY
Einddatum / End date *
MM
/
DD
/
YYYY
Afhaalpunt / Collection point
Gsmnummer / Cellphone number *
Your answer
Bankrekeningnummer / Bank account number *
Your answer
BIC code bank account
Your answer
Rental Regulations *
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