subject_line
Payment of fee / Reimbursement
Name
*
Email
*
Address
*
Country
*
Zip-code
*
City
*
Date of birth (DD/MM/YY)/VAT-#
*
SWIFT or BIC-code
*
IBAN
Amount
*
Currency
Project
*
Contact-person
*
Agnete Seerup
Sigrid Lind
Martin Jensen
Tobias Bendixen
Camilla Juul Kjærgaard
Eva Frost
Lars Thor Jensen
Peter von Freiesleben
Performance/service
*
Date or period
*
+
end-date (if applicable)
+
- the kind of performance/service delivered for the fee (e.g. concert, consulting, booking)
Signature
*
clear
NB: If you are reimbursing expenses through this form, you need to attach the receipt/s in a zip-file here.
Date
*
+
JazzDanmark treats your personal data with care for a maximum of 5 years.