Membership Application

I hereby declare my membership in the customer community of the Ökodorf Brodowin.
As a member of the community I receive a 10% discount on all Brodowin products when ordering in the online shop, 10% discount on all Brodowin products as well as meals and drinks in the farm shop / monastery café and I have free entrance to events and farm tours for Ökodorf Brodowin.

First name*: Name*:  
Customer number (if available): malefemale  
Street, house number*:  
postcode, town*: Birthday*:  
Phone*: E-Mail:  
IBAN*:  
BIC*: Banking institution*:  
Account holder (if different):  
I authorise Ökodorf Brodowin GmbH & Co. Vertriebs KG to draw the membership fee of 10,00 € from my account every month.*  
   
Place, date*:  
I agree with the use/storage of my data.*  
* = Mandatory information  
Your data is securely transmitted to us via SSL encryption.  
 
We use the information you give us exclusively to record your customer data in our register. You will receive regular information by e-mail (if specified) about the Brodowiner delivery service assortment, you can cancel the notification at any time.
Your data will not be forwarded to third parties.