Contact Form - Block Cards

Block card(s)

Please complete this form to request a card blocking.

If you have any questions or requests, please call us on +49 (0) 6196 / 5822 - 902 Monday to Friday between 08:00 and 18:00.

Salutation

This field is mandatory and must be filled in.

Company Name

This field is mandatory and must be filled in.

First Name *

This field is mandatory and must be filled in.

Last Name *

This field is mandatory and must be filled in.

Email *

This field is mandatory and must be filled in.

Blocking Reason *

This field is mandatory and must be filled in.

Blocking date (immediately/at) *

This field is mandatory and must be filled in.

Customer number LOGPAY

This field is mandatory and must be filled in.

Text on Card

This field is mandatory and must be filled in.

Card number

This field is mandatory and must be filled in.

* Mandatory fields (must be completed)

* I have read the privacy policy and hereby agree to it.

This field is mandatory and must be filled in.