Become a Provider - Barcelona Health Hub

Do you want to become a provider of Barcelona Health Hub?

Please fill in the form!
For more information about the fee, please contact contact@barcelonahealthhub.com.

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Provider Application

General Information

Name and Surname*

If the person concerned is a legal entity, please enter the name of the legal representative)

Name and Surname

Job Title

Email*

Primary Email Address

Phone*

Primary Phone Number

Phone

Company/Organization

Corporate Name*

Corporate Name

C.I.F.

Tax ID number

C.I.F.

Web URL*

Web URL

Twitter URL

Address*

Central Offices Address

Address

City/Town

Country

Province

Postal Code

Company Description*

Briefly describe your organization. Please note that we may use this description for publicity purposes (max. 230 characters)

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Services Description *

Briefly describe the services your organization provides for the BHH members (max. 1200 characters)

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Logo Upload

Drag 'n Drop files here

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

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Terms & Conditions*

Barcelona Health Hub Association, with registered address at Sant Antoni María Claret, 167 Pabellón de Sant Manel, Barcelona (C.P.08025) and CIF number G67269308, informs you that the data you provide us through this form in your capacity as a company, legal representative or, where appropriate, individual entrepreneur, will be included in a file owned by the Barcelona Health Hub Association, with the aim of ensuring proper administrative management of the relationship between the Association and its members, as well as to inform and communicate about any fact or activity of the Association, as well as to inform and communicate about any fact or activity of the Association.

Barcelona Health Hub Association will not transfer your data to any third party unless legally obliged to do so.

Barcelona Health Hub Association will keep the data you provide as long as you do not request that they be deleted from our file and, in any case, provided that you maintain a contractual relationship with Barcelona Health Hub Association.

The person submitting the data provided in this form guarantees that the data provided are true, accurate, complete and up to date, being responsible for any damage or injury, direct or indirect, that may be caused to Barcelona Health Hub Association as a result of the breach of such obligation.

You are informed that you may exercise your rights of access, rectification, suppression, limitation of processing, opposition and portability of the data provided in this form, by writing directly to Asociación Barcelona Health Hub, calle Sant Antoni María Claret, 167 Pabellón de Sant Manel, Barcelona (C.P.08025), or by sending a request to admin@barcelonahealthhub.com.

To this end, they declare that they are aware of the Association’s Articles of Association and, in particular, Article 8 relating to the duties of members.

I Agree

Signed

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SEPA B2B Direct Debit Mandate

Debtor and Payment Data

Debtor Name and Address*

Name and Surname

Address

City

Country

Province

Postal Code

Swift BIC*

You can calculate it from your bank account number at https://www.calculatuiban.com/

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Account Number – IBAN*

You can calculate it from your bank account number at https://www.calculatuiban.com/

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Type of Payment*

Creditor Data

Creditor Identifier: G67269308
Creditor’s name: Asociación Barcelona Health Hub
Address: Sant Antoni Mª Claret, 167, Pabellón de Sant Manel
Postal Code: 08025
City: Barcelona
Country: Spain

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Terms & Conditions*

By signing this mandate form, you authorize (A) (NAME OF CREDITOR) to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from (NAME OF CREDITOR). This mandate is only intended for business-to business transactions. You are not entitled to a refund from your bank after your account has been debited, but you are entitled to request your bank not to debit your account up until the day on which the payment is due. Please contact your bank for detailed procedures in such a case.

I Agree

Do you want to become a provider of Barcelona Health Hub?

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Provider Application

General Information

Company/Organization

Logo Upload

Apply

Signed

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SEPA B2B Direct Debit Mandate

Debtor and Payment Data

Creditor Data

Apply

Signature of the debtor

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