Instalment plan by liaoqinmei


									                                                                                                                                      P a t i e n t        I n f o r m a t i o n

                                                                                                                                                            Instalment plan
70014 Stuttgart
Postfach 10 15 44
Rechenzentrum GmbH
Deutsches Zahnärztliches

                             or send in a window envelope to
                             Simply hand in directly at your dentist’s office
                                                                                              DZR Deutsches Zahnärztliches
                                                                                                    Rechenzentrum GmbH

                                                                                          Postfach 10 15 44 · 70014 Stuttgart
                                                                                            Marienstraße 10 · 70178 Stuttgart
                                                                                                 Phone +49 (0) 711 61947-40
                                                                                                    Fax +49 (0) 711 61947-50


                                                                                           Postfach 10 16 53 · 41416 Neuss
                                                                                     Hermann-Klammt-Straße 7 · 41460 Neuss
                                                                                                 Phone +49 (0) 2131 5673-0
                                                                                                  Fax +49 (0) 2131 5673-56


                                                                                         ABZ Zahnärztliches Rechenzentrum
                                                                                                          für Bayern GmbH

                                                                                           Postfach 14 54 · 82182 Gröbenzell
                                                                                         Oppelner Straße 3 · 82194 Gröbenzell
                                                                                                  Phone +49 (0) 8142 6520-6
                                                                                                   Fax +49 (0) 8142 6520-892


                                                                                            HZA Hanseatische Zahnärztliche       No one needs to scrimp and save for first-class
                                                                                                Abrechnungs- und Service-
                                                                                                         Gesellschaft mbH
                                                                                                                                 dental treatment any more these days

                                                                                         Postfach 10 68 40 · 20045 Hamburg
                                                                                        Heidenkampsweg 51 · 20097 Hamburg          simple, quick and unbureaucratic
                                                                                                  Phone +49 (0) 40 237802-0

                                                                                                   Fax +49 (0) 40 237802-78
                                                                                                                                   no need to prove income or pension

                                                                                                                                   monthly instalment starting from 1 25.00 minimum
                                                                                                                                   individual pay-off terms of up to 48 months

                                                                                                                                   free from interest and fees for a pay-off term of
                                                                                      FRH Freies Rechenzentrum Heilberufe
                                                                                                a subsidiary of DZR Deutsches      up to six months
                                                                                Zahnärztliches Rechenzentrum GmbH, Stuttgart

                                                                                          Postfach 10 15 41 · 70014 Stuttgart
                                                                                            Marienstraße 12 · 70178 Stuttgart
                                                                                                Phone +49 (0) 711 36511-200
                                                                                                   Fax +49 (0) 711 36511-201

                                                                                   P a t i e n t                     I n f o r m a t i o n                                                                                I n s t a l m e n t               p l a n         a p p l i c a t i o n

                                               Please note                     Pay-off terms and costs                                                                                                                 Yes, I want to use the instalment plan!
                                              that the translation of our      In case of an instalment plan agreement with a total pay-off term                                                                       Quickly fill out this application after receiving your bill, and send it
                                              application form into your       of more than six months from the billing date, we charge the follo-                                                                     to DZR or hand it in at your dentist’s office.
                                              mother tongue is a voluntary     wing financing costs.
                                              service on our part. As                                                                                                                                                  Within a few days, you will receive your quotation with a prepa-
                                              German law applies, we can       Interest* per month:                                                                                                                    red instalment plan agreement.
                                              only process your partial pay-
                                                                                        7–12 months                  0.35% per month
                                              ment request if you provide
                                                                                       13–24 months                  0.55% per month
                                              us with the signed application                                                                                                                                           Bill recipient
                                                                                       25–48 months                  0.65 % per month
                                              on the German original.
                                                                               Administration fees:
                                              We would like to thank you for
                                              your understanding in this       A one-off fee of 1% is charged on the bill, with 1 10.00 being the
                                                                                                                                                                                                                       First name/Surname
                                              matter.                          minimum fee.

                                              Please note the instructions     The minimum monthly instalment is 1 25.00, however the
                                              on page 3.                       maximum pay-off term is 48 months.

                                                                               You can quite simply request your instalment plan quotation
                                                                               with the attached instalment plan application, or under
                                                                                                                                                                                                                       Postcode, town/city
We all have to save these days! But saving on your dental health

can get painful and expensive in a couple of years. That is why                Examples:
you should ask your dentist for your optimum care and treat-
ment. With us, your dentist has a service provider who can offer                Pay-off term/months                    6 months                 12 months                                                              Date of birth                                Phone
attractive financing models for your co-payment.                                from billing date                     (no charges)

See how easy the instalment plan can be                                         Billing sum in €                     Monthly instalment / total amount
                                                                                                                               in 1 (rounded)
You yourself decide on the amount of the instalments or on the                                                                                                                                                         Invoice no. (please always quote)            Invoice amount
pay-off term. So it is up to you how high the monthly costs will                                          1,000              167                  88 /      1,052
be. You also decide whether the individual payments become
due at the start or in the middle of the month.                                                           2,000              333                 175 /      2,104
                                                                                                                                                                                                                       Please select
                                                                                                          5,000              833                 438 /      5,260
See how the free instalment plan works                                                                                                                                                                                 1.) The amount of the
Provided you pay your bill in between two and at most six                                               10,000             1,667                 877 / 10,520                                                              monthly instalments
equal monthly instalments, no additional costs will arise for                                                                                                                                                                                          approx. €                                        monthly
                                                                                                        20,000             3,333              1,753 / 21,040                                                                                                                at least € 25.00
you as a result of the instalment plan. It is therefore essential
that your written instalment plan request and the first                                                                                                                                                                    or
                                                                                Financing costs
instalment are received by us within 30 days of the
billing date. The billing sum must be paid by you in full within                Interest per month                          0%                     0.35 %                                                                  the pay-off term
six months of the billing date.                                                 Administration fees                         0%                     1.00 %                                                                                                  months

                                                                                                                                                                             Please tear off here at the perforation
                                                                                                                                                                                                                                                                            at most 48 months
                                                                                Effective interest**                        0%                     9.60 %
                                                                                                                                                                                                                       2.) Desired start of payment/date of payment
                                                                                Minimum instalment in 1                      25                       25
The patient-friendly service of:                                                                                                                                                                                                 on the 1st of a month                  on the 15th of a month
DZR Deutsches Zahnärztliches Rechenzentrum GmbH, Marienstraße 10,              * Interest is charged from the billing date on the outstanding invoice amount.
70178 Stuttgart, Phone +49 (0) 711 61947-40, Fax +49 (0) 711 61947-50,         ** The original effective interest, including the administration fee of 1%, is dependent
E-mail:                                                           on the receipt of the first instalment and the total pay-off term from the billing date.
VAT ID No. DE 147839808, Office and local court: Stuttgart HRB 6658,           Note: The terms and financing costs (interest per month and administration fees) will
Executive director: Rudolf Prangen, Thomas Schelhorn,                          be specified in the instalment plan agreement sent to you separately.
Bank details: APO Bank, Sort code 300 606 01, Account No. 000 666 1114                                                                                                                                                 Place/Date                             Signature of the bill recipient/patient
   P l e a s e       p r o c e e d        a s   f o l l o w s :                     T e i l z a h l u n g s w u n s c h

Option 1:                                                                      Ja, ich möchte die Teilzahlung nutzen!
                                                                               Nach Erhalt Ihrer Rechnung bitte schnell dieses Formular ausfül-
1. Fill out the form in your language (page 2) on the PC using                 len und an das DZR senden oder bei Ihrem Zahnarzt abgeben.

                                                                                                                                                                       70014 Stuttgart
                                                                                                                                                                       Postfach 10 15 44
                                                                                                                                                                       Rechenzentrum GmbH
                                                                                                                                                                       Deutsches Zahnärztliches
   Acrobat Reader. Your data will be automatically entered in
   the German form.                                                            Innerhalb weniger Tage erhalten Sie Ihr Angebot mit einer vor-
                                                                               bereiteten Teilzahlungsvereinbarung.
2. Please print out the German form.

                             > Print <                                         Rechnungsempfänger

3. Sign the application

4. Fold the page twice, put it in a window envelope and
   hand it in directly at your dentist's or send it to DZR
   by mail


Option 2:

1. Print this page                                                             Geburtsdatum                                 Telefon-Nr.

                             > Print <
                                                                               Rg.-Nr.(n) (bitte unbedingt angeben)         Rechnungsbetrag

2. Fill out the application and sign it
                                                                               Bitte wählen Sie
3. Fold the page twice, put it in a window envelope and
   hand it in directly at your dentist's or send it to DZR                     1.) die Höhe der Monatsrate
   by mail                                                                                                       ca. Euro                                monatlich
                                                                                                                                 mindestens 25,- Euro

                                                                                   die Laufzeit
                                                                                                                                 maximal 48 Monate

                                                                               2.) gewünschter Zahlungsbeginn/Zahlungstermin

                                                                                         zum 01. eines Monats                   zum 15. eines Monats

                                                                               Ort/Datum                              Unterschrift des Rechnungsempfängers/Patienten

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