MESA Mandate Form

e.g. Examplestreet 1, 1234AA
e.g. Groningen, The Netherlands.
By clicking agree on the mandate agreement, you authorise (A) MESA to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from MESA. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights regarding this mandate are explained in a statement that you can obtain from your bank.
Required for all bank account numbers outside of the Netherlands
You will receive your personal mandate number in your e-mail at a later date.

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