Contacteer me

Vul het formulier in en een van onze medewerkers contacteert je.

Gegevens

{{errorMessages.promoter.required}} {{errorMessages.promoter.pattern}} {{errorMessages.promoter.pattern}} {{errorMessages.promoter.pattern}} {{errorMessages.promoter}} {{errorMessages.promoter.pattern}}
{{errorMessages.FirstName.required}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName}} {{errorMessages.FirstName.pattern}}
{{errorMessages.LastName.required}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName}} {{errorMessages.LastName.pattern}}
{{errorMessages.CALLBACKCLICountry.required}} {{errorMessages.CALLBACKCLICountry}}
{{errorMessages.CALLBACKCLIPhone.required}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone}} {{errorMessages.CALLBACKCLIPhone.pattern}}
{{errorMessages.MAILBACKADDR.required}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR}} {{errorMessages.MAILBACKADDR.pattern}}
{{errorMessages.date.required}} {{errorMessages.date.pattern}} {{errorMessages.date.pattern}} {{errorMessages.date.pattern}} {{errorMessages.date}} {{errorMessages.date.pattern}}
{{errorMessages.remarks.required}} {{errorMessages.remarks.pattern}} {{errorMessages.remarks.pattern}} {{errorMessages.remarks.pattern}} {{errorMessages.remarks}} {{errorMessages.remarks.pattern}}

Nieuw adres

{{errorMessages.street2.required}} {{errorMessages.street2.pattern}} {{errorMessages.street2.pattern}} {{errorMessages.street2.pattern}} {{errorMessages.street2}} {{errorMessages.street2.pattern}}
{{errorMessages.number2.required}} {{errorMessages.number2.pattern}} {{errorMessages.number2.pattern}} {{errorMessages.number2.pattern}} {{errorMessages.number2}} {{errorMessages.number2.pattern}}
{{errorMessages.box2.required}} {{errorMessages.box2.pattern}} {{errorMessages.box2.pattern}} {{errorMessages.box2.pattern}} {{errorMessages.box2}} {{errorMessages.box2.pattern}}
{{errorMessages.zip2.required}} {{errorMessages.zip2.pattern}} {{errorMessages.zip2.pattern}} {{errorMessages.zip2.pattern}} {{errorMessages.zip2}} {{errorMessages.zip2.pattern}}
{{errorMessages.city2.required}} {{errorMessages.city2.pattern}} {{errorMessages.city2.pattern}} {{errorMessages.city2.pattern}} {{errorMessages.city2}} {{errorMessages.city2.pattern}}
Ik verklaar kennis te hebben genomen van de voorwaarden¹ van deze actie en de consumenteninfo² en aanvaard deze.
{{errorMessages.geaanvaard.required}} {{errorMessages.geaanvaard.pattern}}
  1. Bovenop de algemene voorwaarden van Proximus gelden ook volgende specifieke voorwaarden.
  2. Consumenten info op www.proximus.be/consumenteninfo.

Bedankt voor het vertrouwen

Mynewhome team

mynewhome@proximus.com

Even geduld, je gegevens worden verwerkt

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