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Current File : /home/moncbefd/www.moneta.at///fax.html
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<meta http-equiv="content-type" content="text/html;charset=utf-8">
<title>Einzugserm&auml;chtigung</title>
<link rel="stylesheet" type="text/css" href="stylesheet.css">
</head>
<body>
<div align="center"><table width="508" border="0" cellspacing="3" cellpadding="3">
  <tr>
    <td colspan="4" class="tableHeading"><div align="center"><b>Erm&auml;chtigung zum Einzug von Forderungen durch Lastschriften</b></div></td>
  </tr>
  <tr>
    <td colspan="4"><hr size="2"></td>
  </tr>
  <tr>
    <td colspan="2" class="main" class="main"><b>Zahlungsempf&auml;nger</b></td>
    <td colspan="2" class="main"><b>Ihr Name und Ihre Anschrift </b></td>
  </tr>
  <tr>
    <td colspan="2" class="main">Firmenname</td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main">Straße</td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main">Ort</td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main">Tel.:</td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main">Fax:</td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td></td>
    <td></td>
    <td width="25%"></td>
    <td width="25%"></td>
  </tr>
  <tr>
    <td colspan="4"><hr noshade size="1"></td>
  </tr>
  <tr>
    <td colspan="4" class="main">Hiermit erm&auml;chtige(n) ich/wir Sie widerruflich, die von mir/uns zu entrichtenden Zahlungen zu Lasten meines/unseres Kontos mit nachstehenden Daten durch Lastschrift einzuziehen. Wenn mein/unser Konto die erforderliche Deckung nicht aufweist, besteht seitens des kontof&uuml;hrenden Instituts keine Verpflichtung zur Einl&ouml;sung. Teileinl&ouml;sungen werden im Lastschriftverfahren nicht vorgenommen.</td>
  </tr>
  <tr>
    <td colspan="4"></td>
  </tr>
  <tr>
    <td colspan="4"><hr size="1"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><b>Name des Kontinhabers:</b></td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><b>Name der Kreditinstitutes:</b></td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><b>Bankleitzahl:</b></td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><b>Konto-Nummer (nur Girokonten):</b></td>
    <td colspan="2" height="30"><img src="images/einzug.gif" alt="einzug" height="30" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="4"><hr size="1"></td>
  </tr>
  <tr height="30">
    <td colspan="2" height="45"><img src="images/einzug.gif" alt="einzug" height="45" width="100%" border="0"></td>
    <td colspan="2" height="45"><img src="images/einzug.gif" alt="einzug" height="45" width="100%" border="0"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><hr noshade size="3"></td>
    <td colspan="2" class="main"><hr noshade size="3"></td>
  </tr>
  <tr>
    <td colspan="2" class="main"><div align="center">Ort, Datum</div></td>
    <td colspan="2" class="main"><div align="center">Unterschrift</div></td>
  </tr>
  <tr>
    <td></td>
    <td></td>
    <td width="25%"></td>
    <td width="25%"></td>
  </tr>
  <tr>
    <td colspan="4" class="tableHeading"><div align="center"><b>PER&nbsp;FAX&nbsp;AN: </b></font></div></td>
  </tr>
</table></div>
</body>
</html>

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