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Submitted URL: https://www.partnerdswk.brigitteheuser.de/
Effective URL: https://lrworld.jotform.com/231451893585970?partnernummer185=DE01954026&name123=Heuser&email244=brigitte.heuser%40se...
Submission: On August 26 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://lrworld.jotform.com/231451893585970?partnernummer185=DE01954026&name123=Heuser&email244=brigitte.heuser%40se...
Submission: On August 26 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form_231451893585970 — POST https://lrworld.jotform.com/submit/231451893585970
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://lrworld.jotform.com/submit/231451893585970" method="post" name="form_231451893585970" id="231451893585970"
accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="231451893585970"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1724640487599=>init-started:1724641068408=>validator-called:1724641068520=>validator-mounted-true:1724641068521=>init-complete:1724641068527"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1724640487599">
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head" data-css-selector="id_1">
<div style="display:table;width:100%">
<div class="form-header-group hasImage header-large" data-imagealign="Left">
<div class="header-logo"><img src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/LR_logo_PMSgrey%20(002).602bd517a7abc7.18022902.639b2cb2b75a81.20556052.63ca418b659937.73005373.png" alt="PARTNERANTRAG" width="124"
class="header-logo-left"></div>
<div class="header-text httal htvam">
<h1 id="header_1" class="form-header" data-component="header">PARTNERANTRAG</h1>
<div id="subHeader_1" class="form-subHeader">DARM- & STOFFWECHSELKUR</div>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_image" id="id_200" data-css-selector="id_200">
<div id="cid_200" class="form-input-wide" data-layout="full">
<div style="text-align:center" aria-hidden="true" role="none"><img alt="Image-200" loading="lazy" class="form-image" style="border:0"
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</li>
<li class="form-line" data-type="control_image" id="id_202" data-css-selector="id_202">
<div id="cid_202" class="form-input-wide" data-layout="full">
<div style="text-align:center" aria-hidden="true" role="none"><img alt="Image-202" loading="lazy" class="form-image" style="border:0"
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<li id="cid_227" class="form-input-wide" data-type="control_pagebreak" data-css-selector="id_227">
<div class="form-pagebreak" data-component="pagebreak">
<div class="form-pagebreak-back-container"></div>
<div class="form-pagebreak-next-container"><button id="form-pagebreak-next_227" type="button" class="form-pagebreak-next jf-form-buttons" data-component="pagebreak-next">Weiter</button></div>
<div style="clear:both" class="pageInfo form-sub-label" id="pageInfo_227"></div>
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<ul class="form-section page-section" style="display:none;">
<li id="cid_201" class="form-input-wide" data-type="control_head" data-css-selector="id_201">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_201" class="form-header" data-component="header">LR DARM- & STOFFWECHSELKUR - 6 Monate</h2>
<div id="subHeader_201" class="form-subHeader">Ihre Erstbestellung ist versandkostenfrei!</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_checkbox" id="id_204" data-css-selector="id_204"><label class="form-label form-label-top" id="label_204" for="input_204_0" aria-hidden="false"> Sie erhalten folgende Produkte </label>
<div id="cid_204" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_204" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input type="checkbox" aria-describedby="label_204"
disabled="" class="form-checkbox" id="input_204_0" name="q204_lrGesundheitspaket[]" checked="" value="pro Quartal: 9x Aloe Vera Drinking Gel, 6x Colostrum Liquid, 3x Pro Balance, 3x Pro 12"><label id="label_input_204_0"
for="input_204_0">pro Quartal: 9x Aloe Vera Drinking Gel, 6x Colostrum Liquid, 3x Pro Balance, 3x Pro 12</label></span></div>
</div>
</li>
<li class="form-line card-2col jf-required" data-type="control_payment" id="id_179" data-payment="true" data-css-selector="id_179"><label class="form-label form-label-top" id="label_179" for="input_179" aria-hidden="false"> WÄHLEN SIE IHR ALOE
VERA DRINKING GEL AUS<span class="form-required">*</span> </label>
<div id="cid_179" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true">
<div data-wrapper-react="true" class="product-container-wrapper">
<div class="filter-container"></div><input type="hidden" name="simple_fpc" data-payment_type="payment" data-component="payment1" value="179"><input type="hidden" name="payment_transaction_uuid" id="paymentTransactionId"
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<div id="image-overlay" class="overlay-content" style="display:none"><img id="current-image"><span class="lb-prev-button">prev</span><span class="lb-next-button">next</span><span class="lb-close-button">( X )</span><span
class="image-overlay-product-container">
<ul class="form-overlay-item" pid="1022" hasicon="false" hasimages="true" iconvalue="">
<li class="image-overlay-image"><img loading="lazy" src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/2.jpg"></li>
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<ul class="form-overlay-item" pid="1023" hasicon="false" hasimages="true" iconvalue="">
<li class="image-overlay-image"><img loading="lazy" src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/1.jpg"></li>
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<div data-wrapper-react="true"><span class="form-product-item hover-product-item on_col1 show_image show_desc show_option new_ui" categories="2001" active-category="2001" pid="1022" aria-labelledby="label_179">
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aria-label="Select Product: Wählen Sie Sivera, Freedom, Immune Plus oder Acai für Ihr Abo" data-is-default-required="false" data-is-default-selected="false">
<div class="checked"></div>
<div class="select_border"></div>
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<div class="p_image">
<div class="image_area form-product-image-with-options">
<div style="position:absolute;width:100%;height:100%"><img loading="lazy" role="img" aria-label="Wählen Sie Sivera, Freedom, Immune Plus oder Acai für Ihr Abo"
alt="Wählen Sie Sivera, Freedom, Immune Plus oder Acai für Ihr Abo Product Image" style="width:100%;height:100%;object-fit:cover" src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/2.jpg"></div>
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<div for="input_179_1022" class="form-product-container"><span data-wrapper-react="true">
<div class="title_description"><span class="form-product-name" id="product-name-input_179_1022">Wählen Sie Sivera, Freedom, Immune Plus oder Acai für Ihr Abo</span><span class="form-product-description"
id="product-name-description-input_179_1022">1405 PW · 413,18 GV EK brutto (pro Quartal): 549,00 € Mtl. Preis bei Ratenzahlung: 183,30 €</span></div><span
class="form-product-details"><b><span data-wrapper-react="true">€<span id="input_179_1022_price">183.30</span></span></b></span>
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<option value="Active Freedom">Active Freedom</option>
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<option value="Açai Pro Summer">Açai Pro Summer</option>
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<div class="focus_action_button_container">
<a class="btn-inline-product-delete" tabindex="0" role="button" aria-label="Produkt löschen"> </a><a class="btn-inline-product-settings" tabindex="0" role="button" aria-label="Produkt Einstellungen"> </a></div>
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</span>
<div class="p_item_separator "></div><span class="form-product-item hover-product-item on_col2 show_image show_desc show_option new_ui" categories="non-categorized" pid="1023" aria-labelledby="label_179">
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aria-label="Select Product: Wählen Sie Honey oder Peach für Ihr Abo" data-is-default-required="false" data-is-default-selected="false">
<div class="checked"></div>
<div class="select_border"></div>
</div>
</div>
<div class="p_image">
<div class="image_area form-product-image-with-options">
<div style="position:absolute;width:100%;height:100%"><img loading="lazy" role="img" aria-label="Wählen Sie Honey oder Peach für Ihr Abo" alt="Wählen Sie Honey oder Peach für Ihr Abo Product Image"
style="width:100%;height:100%;object-fit:cover" src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/1.jpg"></div>
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<div for="input_179_1023" class="form-product-container"><span data-wrapper-react="true">
<div class="title_description"><span class="form-product-name" id="product-name-input_179_1023">Wählen Sie Honey oder Peach für Ihr Abo</span><span class="form-product-description"
id="product-name-description-input_179_1023">1335 PW · 394,60 GV EK brutto (pro Quartal): 523,90 € Mtl. Preis bei Ratenzahlung: 174,63 €</span></div><span
class="form-product-details"><b><span data-wrapper-react="true">€<span id="input_179_1023_price">174.63</span></span></b></span>
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<option value="Traditionell Honey">Traditionell Honey</option>
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<div class="focus_action_button_container">
<a class="btn-inline-product-delete" tabindex="0" role="button" aria-label="Produkt löschen"> </a><a class="btn-inline-product-settings" tabindex="0" role="button" aria-label="Produkt Einstellungen"> </a></div>
</div>
</span>
<div class="payment_footer new_ui ">
<div class="total_area"></div>
</div>
</div>
</div>
</div>
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<li class="form-line" data-type="control_widget" id="id_266" data-css-selector="id_266"><label class="form-label form-label-top" id="label_266" for="input_266" aria-hidden="false"> Bitte wählen Sie weitere Produkte aus </label>
<div id="cid_266" class="form-input-wide" data-layout="full">
<div data-widget-name="Konfigurierbare Liste" style="width:100%;text-align:Left;overflow-x:auto" data-component="widget-field"><iframe data-client-id="533946093c1ad0c45d000070" title="Konfigurierbare Liste" frameborder="0" scrolling="no"
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<li class="form-line jf-required" data-type="control_radio" id="id_240" data-css-selector="id_240"><label class="form-label form-label-top" id="label_240" aria-hidden="false"> Ich bezahle per<span class="form-required">*</span> </label>
<div id="cid_240" class="form-input-wide jf-required" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_240" data-component="radio"><span class="form-radio-item"><span class="dragger-item"></span><input type="radio" aria-describedby="label_240"
class="form-radio validate[required]" id="input_240_0" name="q240_ichBezahle" value="Lastschriftverfahren mit Ratenzahlung* (Voraussetzung: positive Schufa) Bitte das SEPA-Mandat (siehe unten) ausfüllen" required=""><label
id="label_input_240_0" for="input_240_0">Lastschriftverfahren mit Ratenzahlung* (Voraussetzung: positive Schufa) Bitte das SEPA-Mandat (siehe unten) ausfüllen</label></span><span class="form-radio-item"><span
class="dragger-item"></span><input type="radio" aria-describedby="label_240" class="form-radio validate[required]" id="input_240_1" name="q240_ichBezahle"
value="Nachnahme - keine Ratenzahlung möglich (Bei Zahlung per Nachnahme fallen zusätzliche Nachnahmegebühren in Höhe von 6,28€ brutto an.)" required=""><label id="label_input_240_1" for="input_240_1">Nachnahme - keine Ratenzahlung
möglich (Bei Zahlung per Nachnahme fallen zusätzliche Nachnahmegebühren in Höhe von 6,28€ brutto an.)</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_188" data-css-selector="id_188">
<div id="cid_188" class="form-input-wide" data-layout="full">
<div id="text_188" class="form-html" data-component="text" tabindex="0">
<div style="text-align: left;"><span style="font-size: 8pt;">*Ich ermächtige die LR Health & Beauty Systems GmbH zum Einzug der jeweiligen Rechnungsbeträge gemäß dem SEPA-Lastschriftmandat. Bitte das entsprechende
SEPA-Lastschriftmandat (siehe unten) ausfüllen.</span><br> </div>
<div style="text-align: left;"><span style="font-size: 8pt;"><em>Lieferung erfolgt vierteljährlich. Das Abonnement gilt zunächst für sechs Monate (Mindestlaufzeit) und kann mit einer Frist von einem Monat zum Ende der Mindestlaufzeit
gekündigt werden. <br>Wird das Abonnement nicht gekündigt, so verlängert es sich automatisch auf unbestimmte Zeit und <br>kann dann jederzeit mit einer Frist von einem Monat gekündigt werden. </em></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_206" data-css-selector="id_206">
<div id="cid_206" class="form-input-wide" data-layout="full">
<div id="text_206" class="form-html" data-component="text" tabindex="0">
<p><span style="font-size: 8pt;">Ich habe die umseitigen <strong>Geschäftsbedingungen für LR Partner</strong>, die beiliegenden <strong>Liefer- und Zahlungsbedingungen</strong>, die <strong>Widerrufsbelehrung</strong>,
<strong>Datenschutzerklärung</strong> sowie den <strong>Verhaltenskodex für LR Partner (www.lrworld.com/de/unsere-werte/verhaltenskodex)</strong> gelesen </span><span style="font-size: 8pt;">und stimme ihnen zu.</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_207" data-css-selector="id_207">
<div id="cid_207" class="form-input-wide" data-layout="full">
<div id="text_207" class="form-html" data-component="text" tabindex="0">
<p><span style="font-family: arial, helvetica, sans-serif; font-size: 8pt;"><strong>I</strong><strong>hr Vertragspartner: LR Health & Beauty Systems GmbH</strong>, Kruppstraße 55, 59227 Ahlen, Handelsregisternummer: HRB 10011
Amtsgericht Münster, Geschäftsführer: Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen, Patrick Sostmann, USt-IdNr.: DE 814331344, WEEE-Nr.: DE 47983902</span></p>
</div>
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<ul class="form-section-closed" style="height: 84px;clear:both;" id="section_233">
<li id="cid_233" class="form-input-wide" data-type="control_collapse" data-css-selector="id_233">
<div class="form-collapse-table" id="collapse_233" data-component="collapse" role="button" tabindex="0" aria-pressed="false"><span class="form-collapse-mid" id="collapse-text_233">Bitte tragen Sie hier Ihre persönlichen Daten ein
</span><span class="form-collapse-right form-collapse-right-hide"> </span></div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_143" data-css-selector="id_143"><label class="form-label form-label-top form-label-auto" id="label_143" aria-hidden="false"> Antragssteller 1<span
class="form-required">*</span> </label>
<div id="cid_143" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_143" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_143"
class="form-radio validate[required]" id="input_143_0" name="q143_schreibenSie143" value="Frau" required=""><label id="label_input_143_0" for="input_143_0">Frau</label></span><span class="form-radio-item" style="clear:left"><span
class="dragger-item"></span><input type="radio" aria-describedby="label_143" class="form-radio validate[required]" id="input_143_1" name="q143_schreibenSie143" value="Herr" required=""><label id="label_input_143_1"
for="input_143_1">Herr</label></span></div>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_textbox" id="id_133" data-css-selector="id_133"><label class="form-label form-label-top form-label-auto" id="label_133" for="input_133" aria-hidden="false">
Vorname<span class="form-required">*</span> </label>
<div id="cid_133" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_133" name="q133_vorname" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px"
size="310" data-component="textbox" aria-labelledby="label_133" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-2 jf-required" data-type="control_textbox" id="id_129" data-css-selector="id_129"><label class="form-label form-label-top form-label-auto" id="label_129" for="input_129" aria-hidden="false">
Name<span class="form-required">*</span> </label>
<div id="cid_129" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_129" name="q129_name" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px"
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</li>
<li class="form-line jf-required" data-type="control_datetime" id="id_131" data-css-selector="id_131"><label class="form-label form-label-top form-label-auto" id="label_131" for="lite_mode_131" aria-hidden="false"> Geburtsdatum<span
class="form-required">*</span> </label>
<div id="cid_131" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="day_131" name="q131_geburtsdatum131[day]" size="2" data-maxlength="2"
data-age="" maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_131 sublabel_131_day" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label"
for="day_131" id="sublabel_131_day" style="min-height:13px">Tag</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="month_131"
name="q131_geburtsdatum131[month]" size="2" data-maxlength="2" data-age="" maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_131 sublabel_131_month" inputmode="numeric"><span class="date-separate"
aria-hidden="true"> -</span><label class="form-sub-label" for="month_131" id="sublabel_131_month" style="min-height:13px">Monat</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel"
class="form-textbox validate[required, limitDate]" id="year_131" name="q131_geburtsdatum131[year]" size="4" data-maxlength="4" data-age="" maxlength="4" value="" required="" autocomplete="off"
aria-labelledby="label_131 sublabel_131_year"><label class="form-sub-label" for="year_131" id="sublabel_131_year" style="min-height:13px">Jahr</label></span></div><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_131" size="12" data-maxlength="12" data-age="" value="" required="" data-format="ddmmyyyy"
data-seperator="-" placeholder="TT-MM-JJJJ" data-placeholder="DD-MM-YYYY" autocomplete="off" aria-labelledby="label_131 sublabel_131_litemode" inputmode="numeric"><img class=" newDefaultTheme-dateIcon icon-liteMode"
alt="Wählen Sie ein Datum" id="input_131_pick" src="https://lrworld.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2" aria-label="Choose Date" role="button"
tabindex="0" aria-haspopup="dialog" aria-expanded="false"><label class="form-sub-label" for="lite_mode_131" id="sublabel_131_litemode" style="min-height:13px">Datum</label></span>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_130" data-css-selector="id_130"><label class="form-label form-label-top form-label-auto" id="label_130" for="input_130" aria-hidden="false"> Straße<span
class="form-required">*</span> </label>
<div id="cid_130" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_130" name="q130_strae" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px"
size="310" data-component="textbox" aria-labelledby="label_130" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_textbox" id="id_241" data-css-selector="id_241"><label class="form-label form-label-top form-label-auto" id="label_241" for="input_241" aria-hidden="false">
Hausnummer<span class="form-required">*</span> </label>
<div id="cid_241" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_241" name="q241_hausnummer" data-type="input-textbox" class="form-textbox validate[required, Numeric]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_241" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_264" data-css-selector="id_264"><label class="form-label form-label-top form-label-auto" id="label_264" for="input_264" aria-hidden="false"> Zusatz </label>
<div id="cid_264" class="form-input-wide" data-layout="half"> <input type="text" id="input_264" name="q264_zusatz" data-type="input-textbox" class="form-textbox validate[AlphaNumeric]" data-defaultvalue="" style="width:310px" size="310"
data-component="textbox" aria-labelledby="label_264" value=""> </div>
</li>
<li class="form-line form-line-column form-col-3 jf-required" data-type="control_textbox" id="id_134" data-css-selector="id_134"><label class="form-label form-label-top form-label-auto" id="label_134" for="input_134" aria-hidden="false">
PLZ<span class="form-required">*</span> </label>
<div id="cid_134" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_134" name="q134_plz" data-type="input-textbox" class="form-textbox validate[required, Numeric]" data-defaultvalue="" style="width:310px"
size="310" data-component="textbox" aria-labelledby="label_134" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-4 jf-required" data-type="control_textbox" id="id_258" data-css-selector="id_258"><label class="form-label form-label-top form-label-auto" id="label_258" for="input_258" aria-hidden="false">
Ort<span class="form-required">*</span> </label>
<div id="cid_258" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_258" name="q258_plzort258" data-type="input-textbox" class="form-textbox validate[required, Alphabetic]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_258" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-5" data-type="control_textbox" id="id_135" data-css-selector="id_135"><label class="form-label form-label-top" id="label_135" for="input_135" aria-hidden="false"> Telefonnummer </label>
<div id="cid_135" class="form-input-wide" data-layout="half"> <input type="text" id="input_135" name="q135_telefonnummer" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310"
data-component="textbox" aria-labelledby="label_135" value=""> </div>
</li>
<li class="form-line form-line-column form-col-6" data-type="control_textbox" id="id_259" data-css-selector="id_259"><label class="form-label form-label-top" id="label_259" for="input_259" aria-hidden="false"> Handynummer </label>
<div id="cid_259" class="form-input-wide" data-layout="half"> <input type="text" id="input_259" name="q259_handynummer" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310"
data-component="textbox" aria-labelledby="label_259" value=""> </div>
</li>
<li class="form-line form-line-column form-col-7 jf-required" data-type="control_email" id="id_221" data-css-selector="id_221"><label class="form-label form-label-top" id="label_221" for="input_221" aria-hidden="false"> E-mail<span
class="form-required">*</span> </label>
<div id="cid_221" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_221" name="q221_email" class="form-textbox validate[required, Email]"
data-defaultvalue="" autocomplete="section-input_221 email" style="width:310px" size="310" placeholder="ex: email@yahoo.com" data-component="email" aria-labelledby="label_221 sublabel_input_221" required="" value=""><br><label
class="form-sub-label" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap" for="input_221_confirm">Confirmation Email</label><input type="email"
id="input_221_confirm" name="q221_email" class="form-textbox validate[required, Email, Email_Confirm]" data-defaultvalue="" autocomplete="nope" style="margin-top:8px;width:310px" size="310" placeholder="Confirm Email"
data-component="emailConfirmation" aria-labelledby="" value="" onpaste="return false;"><label class="form-sub-label" for="input_221" id="sublabel_input_221" style="min-height:13px">example@example.com</label></span> </div>
</li>
<li class="form-line" data-type="control_radio" id="id_144" data-css-selector="id_144"><label class="form-label form-label-top" id="label_144" aria-hidden="false"> Antragssteller 2 </label>
<div id="cid_144" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_144" data-component="radio"><span class="form-radio-item"><span class="dragger-item"></span><input type="radio" aria-describedby="label_144"
class="form-radio" id="input_144_0" name="q144_antragssteller2" value="Frau"><label id="label_input_144_0" for="input_144_0">Frau</label></span><span class="form-radio-item"><span class="dragger-item"></span><input type="radio"
aria-describedby="label_144" class="form-radio" id="input_144_1" name="q144_antragssteller2" value="Herr"><label id="label_input_144_1" for="input_144_1">Herr</label></span></div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_124" data-css-selector="id_124"><label class="form-label form-label-top form-label-auto" id="label_124" for="input_124" aria-hidden="false"> Vorname </label>
<div id="cid_124" class="form-input-wide" data-layout="half"> <input type="text" id="input_124" name="q124_vorname124" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310"
data-component="textbox" aria-labelledby="label_124" value=""> </div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_137" data-css-selector="id_137"><label class="form-label form-label-top form-label-auto" id="label_137" for="input_137" aria-hidden="false"> Name </label>
<div id="cid_137" class="form-input-wide" data-layout="half"> <input type="text" id="input_137" name="q137_name137" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
aria-labelledby="label_137" value=""> </div>
</li>
<li class="form-line" data-type="control_datetime" id="id_127" data-css-selector="id_127"><label class="form-label form-label-top form-label-auto" id="label_127" for="lite_mode_127" aria-hidden="false"> Geburtsdatum </label>
<div id="cid_127" class="form-input-wide" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_127" name="q127_geburtsdatum127[day]" size="2" data-maxlength="2" data-age=""
maxlength="2" value="" autocomplete="off" aria-labelledby="label_127 sublabel_127_day" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label" for="day_127"
id="sublabel_127_day" style="min-height:13px">Tag</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_127"
name="q127_geburtsdatum127[month]" size="2" data-maxlength="2" data-age="" maxlength="2" value="" autocomplete="off" aria-labelledby="label_127 sublabel_127_month" inputmode="numeric"><span class="date-separate"
aria-hidden="true"> -</span><label class="form-sub-label" for="month_127" id="sublabel_127_month" style="min-height:13px">Monat</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel"
class="form-textbox validate[limitDate]" id="year_127" name="q127_geburtsdatum127[year]" size="4" data-maxlength="4" data-age="" maxlength="4" value="" autocomplete="off" aria-labelledby="label_127 sublabel_127_year"><label
class="form-sub-label" for="year_127" id="sublabel_127_year" style="min-height:13px">Jahr</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_127" size="12" data-maxlength="12" data-age="" value="" data-format="ddmmyyyy" data-seperator="-" placeholder="TT-MM-JJJJ" data-placeholder="DD-MM-YYYY"
autocomplete="off" aria-labelledby="label_127 sublabel_127_litemode" inputmode="numeric"><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Wählen Sie ein Datum" id="input_127_pick"
src="https://lrworld.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2" aria-label="Choose Date" role="button" tabindex="0" aria-haspopup="dialog"
aria-expanded="false"><label class="form-sub-label" for="lite_mode_127" id="sublabel_127_litemode" style="min-height:13px">Datum</label></span>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_136" data-css-selector="id_136">
<div id="cid_136" class="form-input-wide" data-layout="full">
<div id="text_136" class="form-html" data-component="text" tabindex="0">
<p><span style="font-size: 14pt;"><strong>Vermittler <br><br></strong></span></p>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_185" data-css-selector="id_185"><label class="form-label form-label-top" id="label_185" for="input_185" aria-hidden="false"> Partnernummer </label>
<div id="cid_185" class="form-input-wide" data-layout="half"> <input type="text" id="input_185" name="q185_partnernummer185" data-type="input-textbox" class="form-textbox validate[Fill Mask]" data-defaultvalue="" style="width:310px"
size="310" data-masked="true" data-component="textbox" aria-labelledby="label_185" value="" inputmode="text" maskvalue="(@@)########"> </div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_123" data-css-selector="id_123"><label class="form-label form-label-top form-label-auto" id="label_123" for="input_123" aria-hidden="false"> Name </label>
<div id="cid_123" class="form-input-wide" data-layout="half"> <input type="text" id="input_123" name="q123_name123" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
aria-labelledby="label_123" value=""> </div>
</li>
<li class="form-line form-line-column form-col-3 always-hidden" data-type="control_email" id="id_244" data-css-selector="id_244"><label class="form-label form-label-top" id="label_244" for="input_244" aria-hidden="false"> E-mail </label>
<div id="cid_244" class="form-input-wide always-hidden" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_244" name="q244_email244" class="form-textbox validate[Email]"
data-defaultvalue="" autocomplete="section-input_244 email" style="width:310px" size="310" placeholder="ex: email@yahoo.com" data-component="email" aria-labelledby="label_244 sublabel_input_244" value=""><label class="form-sub-label"
for="input_244" id="sublabel_input_244" style="min-height:13px">example@example.com</label></span> </div>
</li>
<li class="form-line" data-type="control_text" id="id_225" data-css-selector="id_225">
<div id="cid_225" class="form-input-wide" data-layout="full">
<div id="text_225" class="form-html" data-component="text" tabindex="0">
<p><span style="font-family: arial, helvetica, sans-serif; font-size: 8pt;"><strong>I</strong><strong>hr Vertragspartner: LR Health & Beauty Systems GmbH</strong>, Kruppstraße 55, 59227 Ahlen, Handelsregisternummer: HRB 10011
Amtsgericht Münster, Geschäftsführer: Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen, Patrick Sostmann, USt-IdNr.: DE 814331344, WEEE-Nr.: DE 47983902</span></p>
</div>
</div>
</li>
</ul>
<ul class="form-section-closed" style="height: 84px; clear: both; overflow: hidden;" id="section_214">
<li id="cid_214" class="form-input-wide" data-type="control_collapse" data-css-selector="id_214">
<div class="form-collapse-table" id="collapse_214" data-component="collapse" role="button" tabindex="0" aria-pressed="false"><span class="form-collapse-mid" id="collapse-text_214">SEPA LASTSCHRIFTMANDAT</span><span
class="form-collapse-right form-collapse-right-hide"> </span></div>
</li>
<li id="cid_246" class="form-input-wide" style="" data-type="control_head" data-css-selector="id_246">
<div style="display:table;width:100%">
<div class="form-header-group hasImage header-default" data-imagealign="Left">
<div class="header-logo"><img src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/Bild10.6470928fcf39b7.43981523.png" alt="SEPA-LASTSCHRIFTMANDAT" width="140" class="header-logo-left"></div>
<div class="header-text httal htvam">
<h2 id="header_246" class="form-header" data-component="header">SEPA-LASTSCHRIFTMANDAT</h2>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_247" data-css-selector="id_247">
<div id="cid_247" class="form-input-wide" data-layout="full">
<div id="text_247" class="form-html" data-component="text" tabindex="0">
<p> </p>
<table style="height: 86px; width: 609px;">
<tbody>
<tr>
<td style="width: 316.117px;">LR Health & Beauty Systems GmbH<br>Kruppstraße 55<br>59227 Ahlen<br>Deutschland</td>
<td style="width: 276.883px;">Gläubiger-Identifikationsnummer DE56ZZZ00000433133</td>
</tr>
</tbody>
</table>
<p> </p>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_248" data-css-selector="id_248">
<div id="cid_248" class="form-input-wide" data-layout="full">
<div id="text_248" class="form-html" data-component="text" tabindex="0">
<p><span style="font-size: 8pt;">Ich ermächtige (Wir ermächtigen) LR Health & Beauty Systems GmbH widerruflich, Zahlungen von meinem (unserem) Konto mittels </span><span style="font-size: 8pt;">Lastschrift einzuziehen. Zugleich
weise ich mein (weisen wir unser) Kreditinstitut an, die von LR Health & Beauty Systems GmbH auf </span><span style="font-size: 8pt;">mein (unser) Konto gezogenen Lastschriften einzulösen.</span><br><br><span
style="font-size: 8pt;"><strong>Hinweis:</strong> Ich kann (Wir können) innerhalb von acht Wochen, beginnend mit dem Belastungsdatum, die Erstattung des belasteten </span><span style="font-size: 8pt;">Betrages verlangen. Es gelten
dabei die mit meinem (unserem) Kreditinstitut vereinbarten Bedingungen</span></p>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_textbox" id="id_249" data-css-selector="id_249"><label class="form-label form-label-top" id="label_249" for="input_249" aria-hidden="false"> Vorname <span
class="form-required">*</span> </label>
<div id="cid_249" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_249" name="q249_vorname249" data-type="input-textbox"
class="form-textbox validate[required]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_249 sublabel_input_249" required="" value=""><label class="form-sub-label" for="input_249"
id="sublabel_input_249" style="min-height:13px"> (Kontoinhaber/Antragssteller)</label></span> </div>
</li>
<li class="form-line form-line-column form-col-2 jf-required" data-type="control_textbox" id="id_260" data-css-selector="id_260"><label class="form-label form-label-top" id="label_260" for="input_260" aria-hidden="false"> Name<span
class="form-required">*</span> </label>
<div id="cid_260" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_260" name="q260_name260" data-type="input-textbox"
class="form-textbox validate[required]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_260 sublabel_input_260" required="" value=""><label class="form-sub-label" for="input_260"
id="sublabel_input_260" style="min-height:13px"> (Kontoinhaber/Antragssteller)</label></span> </div>
</li>
<li class="form-line form-line-column form-col-3 jf-required" data-type="control_textbox" id="id_250" data-css-selector="id_250"><label class="form-label form-label-top form-label-auto" id="label_250" for="input_250" aria-hidden="false">
Postleitzahl<span class="form-required">*</span> </label>
<div id="cid_250" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_250" name="q250_postleitzahl" data-type="input-textbox" class="form-textbox validate[required, Numeric]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_250" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-4 jf-required" data-type="control_textbox" id="id_261" data-css-selector="id_261"><label class="form-label form-label-top form-label-auto" id="label_261" for="input_261" aria-hidden="false">
Ort<span class="form-required">*</span> </label>
<div id="cid_261" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_261" name="q261_ort" data-type="input-textbox" class="form-textbox validate[required, Alphabetic]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_261" required="" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_251" data-css-selector="id_251"><label class="form-label form-label-top form-label-auto" id="label_251" for="input_251" aria-hidden="false"> Straße<span
class="form-required">*</span> </label>
<div id="cid_251" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_251" name="q251_strae251" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" style="width:310px"
size="310" data-component="textbox" aria-labelledby="label_251" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_textbox" id="id_262" data-css-selector="id_262"><label class="form-label form-label-top form-label-auto" id="label_262" for="input_262" aria-hidden="false">
Hausnummer<span class="form-required">*</span> </label>
<div id="cid_262" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_262" name="q262_hausnummer262" data-type="input-textbox" class="form-textbox validate[required, Numeric]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_262" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_265" data-css-selector="id_265"><label class="form-label form-label-top form-label-auto" id="label_265" for="input_265" aria-hidden="false"> Zusatz </label>
<div id="cid_265" class="form-input-wide" data-layout="half"> <input type="text" id="input_265" name="q265_zusatz265" data-type="input-textbox" class="form-textbox validate[AlphaNumeric]" data-defaultvalue="" style="width:310px" size="310"
data-component="textbox" aria-labelledby="label_265" value=""> </div>
</li>
<li class="form-line fixed-width jf-required" data-type="control_textbox" id="id_252" data-css-selector="id_252"><label class="form-label form-label-top" id="label_252" for="input_252" aria-hidden="false"> IBAN (mit Leerzeichen eingeben)
<span class="form-required">*</span> </label>
<div id="cid_252" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_252" name="q252_ibanmit" data-type="input-textbox"
class="form-textbox validate[required, AlphaNumeric, minCharLimit]" data-defaultvalue="" style="width:800px" size="800" maxlength="27" data-minlength="1" data-component="textbox" aria-labelledby="label_252 sublabel_input_252"
required="" value=""><label class="form-sub-label" for="input_252" id="sublabel_input_252" style="min-height:13px">(Ihre IBAN finden Sie auch auf Ihrem Kontoauszug)</label></span> </div>
</li>
<li class="form-line fixed-width" data-type="control_textbox" id="id_253" data-css-selector="id_253"><label class="form-label form-label-top" id="label_253" for="input_253" aria-hidden="false"> BIC </label>
<div id="cid_253" class="form-input-wide" data-layout="half"> <input type="text" id="input_253" name="q253_bic253" data-type="input-textbox" class="form-textbox validate[Fill Mask]" data-defaultvalue="" style="width:800px" size="800"
data-component="textbox" aria-labelledby="label_253" value=""> </div>
</li>
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_textbox" id="id_254" data-css-selector="id_254"><label class="form-label form-label-top" id="label_254" for="input_254" aria-hidden="false"> Ort<span
class="form-required">*</span> </label>
<div id="cid_254" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_254" name="q254_ort254" data-type="input-textbox" class="form-textbox validate[required, Alphabetic]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_254" required="" value=""> </div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_datetime" id="id_255" data-css-selector="id_255"><label class="form-label form-label-top" id="label_255" for="lite_mode_255" aria-hidden="false"> Datum </label>
<div id="cid_255" class="form-input-wide" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" readonly="" class="currentDate form-textbox validate[limitDate]" id="day_255" name="q255_datum255[day]" size="2"
data-maxlength="2" data-age="" maxlength="2" value="25" autocomplete="off" aria-labelledby="label_255 sublabel_255_day" inputmode="numeric"><span class="date-separate" aria-hidden="true"> -</span><label class="form-sub-label"
for="day_255" id="sublabel_255_day" style="min-height:13px">Tag</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" readonly="" class="form-textbox validate[limitDate]" id="month_255"
name="q255_datum255[month]" size="2" data-maxlength="2" data-age="" maxlength="2" value="08" autocomplete="off" aria-labelledby="label_255 sublabel_255_month" inputmode="numeric"><span class="date-separate"
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aria-labelledby="label_255 sublabel_255_year"><label class="form-sub-label" for="year_255" id="sublabel_255_year" style="min-height:13px">Jahr</label></span></div><span class="form-sub-label-container"
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class="form-required">*</span> </label>
<div id="cid_256" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
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<div class="signature-line signature-wrapper signature-placeholder" data-component="signature">
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<div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas
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<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Löschen</span></aside>
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<div id="cid_257" class="form-input-wide" data-layout="full">
<div id="text_257" class="form-html" data-component="text" tabindex="0">
<p style="text-align: center;"><span style="font-size: 14pt;"><span style="font-size: 8pt;">Ihr Vertragspartner: LR Health & Beauty Systems GmbH, Kruppstraße 55, 59227 Ahlen · <br>Tel: +49 (0) 23 82/78 13-0 ·
www.LRworld.com</span><br><span style="font-size: 8pt;">Bestellannahme: Tel: +49 (0) 23 82/70 60-81 · Fax: +49 (0) 23 82/70 60-905/906/907 · bestellung@LRworld.com</span><br><span style="font-size: 8pt;">Service-Hotline: Tel: +49
(0) 23 82/70 60-72 · Fax: +49 (0) 23 82/70 60-311 · service@LRworld.com</span><br><span style="font-size: 8pt;">HRB 10011 Amtsgericht Münster · <br>Geschäftsführer: Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen, Patrick
Sostmann</span><br><span style="font-size: 8pt;">Bankverbindung: Commerzbank AG (BLZ 412 800 43) Konto-Nr. 560 112 500 · IBAN: DE15412800430560112500 · BIC: DRESDEFF413 · USt-IdNr.: DE814331344</span>
<br><strong><br></strong></span></p>
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<div class="form-collapse-table" id="collapse_245" data-component="collapse" role="button" tabindex="0" aria-pressed="false"><span class="form-collapse-mid" id="collapse-text_245">Liefer- und Zahlungsbedingungen</span><span
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<div class="form-collapse-table" id="collapse_180" data-component="collapse" role="button" tabindex="0" aria-pressed="false"><span class="form-collapse-mid" id="collapse-text_180">Geschäftsbedingungen für LR Partner</span><span
class="form-collapse-right form-collapse-right-hide"> </span></div>
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<li class="form-line" data-type="control_image" id="id_235" data-css-selector="id_235">
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height="893px" width="604px" data-component="image" role="none" aria-hidden="true" tabindex="-1"></div>
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src="https://lrworld.jotform.com/uploads/LRDeutschland/form_files/Datenschutz.6481652348bc28.77343569.png" height="883px" width="604px" data-component="image" role="none" aria-hidden="true" tabindex="-1"></div>
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<div class="form-pagebreak" data-component="pagebreak">
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<div class="form-pagebreak-next-container"><button id="form-pagebreak-next_239" type="button" class="form-pagebreak-next jf-form-buttons" data-component="pagebreak-next">Weiter</button></div>
<div style="clear:both" class="pageInfo form-sub-label" id="pageInfo_239"></div>
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<ul class="form-section page-section" style="display:none;">
<li class="form-line form-line-column form-col-1 jf-required" data-type="control_signature" id="id_175" data-css-selector="id_175"><label class="form-label form-label-top form-label-auto" id="label_175" for="input_175" aria-hidden="false">
Unterschrift<span class="form-required">*</span> </label>
<div id="cid_175" class="form-input-wide jf-required" data-layout="half">
<div data-wrapper-react="true">
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<div id="sig_pad_175" data-width="310" data-height="114" data-id="175" data-required="true" class="pad validate[required]" aria-labelledby="label_175">
<div style="padding:0 !important; margin:0 !important;width: 100% !important; height: 0 !important; -ms-touch-action: none; touch-action: none;margin-top:-1em !important; margin-bottom:1em !important;"></div><canvas
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<aside class="signature-pad-aside"><span class="clear-pad-btn clear-pad" role="button" tabindex="0">Löschen</span></aside>
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<li class="form-line allowTime" data-type="control_datetime" id="id_194" data-css-selector="id_194"><label class="form-label form-label-top form-label-auto" id="label_194" for="lite_mode_194" aria-hidden="false"> Datum </label>
<div id="cid_194" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true" class="extended">
<div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" readonly="" class="currentDate form-textbox validate[limitDate]" id="day_194" name="q194_datum[day]" size="2" data-maxlength="2"
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for="input_194_timeInput" id="sublabel_194_hour" style="min-height:13px">Stunde Minuten</label></span></div>
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<div class="form-pagebreak-back-container"><button id="form-pagebreak-back_227" type="button" class="form-submit-button-green-400 form-pagebreak-back jf-form-buttons" data-component="pagebreak-back">Zurück</button></div><button
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</form>Text Content
* PARTNERANTRAG
DARM- & STOFFWECHSELKUR
*
*
* Weiter
* LR DARM- & STOFFWECHSELKUR - 6 MONATE
Ihre Erstbestellung ist versandkostenfrei!
* Sie erhalten folgende Produkte
pro Quartal: 9x Aloe Vera Drinking Gel, 6x Colostrum Liquid, 3x Pro Balance,
3x Pro 12
* WÄHLEN SIE IHR ALOE VERA DRINKING GEL AUS*
prevnext( X )
*
*
Wählen Sie Sivera, Freedom, Immune Plus oder Acai für Ihr Abo1405 PW · 413,18
GV EK brutto (pro Quartal): 549,00 € Mtl. Preis bei Ratenzahlung: 183,30 €
€183.30 Auswahl Intense Sivera Active Freedom Immune Plus Açai Pro Summer
Wählen Sie Honey oder Peach für Ihr Abo1335 PW · 394,60 GV EK brutto (pro
Quartal): 523,90 € Mtl. Preis bei Ratenzahlung: 174,63 €
€174.63 Auswahl Traditionell Honey Peach
* Bitte wählen Sie weitere Produkte aus
* Ich bezahle per*
Lastschriftverfahren mit Ratenzahlung* (Voraussetzung: positive Schufa) Bitte
das SEPA-Mandat (siehe unten) ausfüllenNachnahme - keine Ratenzahlung möglich
(Bei Zahlung per Nachnahme fallen zusätzliche Nachnahmegebühren in Höhe von
6,28€ brutto an.)
* *Ich ermächtige die LR Health & Beauty Systems GmbH zum Einzug der jeweiligen
Rechnungsbeträge gemäß dem SEPA-Lastschriftmandat. Bitte das entsprechende
SEPA-Lastschriftmandat (siehe unten) ausfüllen.
Lieferung erfolgt vierteljährlich. Das Abonnement gilt zunächst für sechs
Monate (Mindestlaufzeit) und kann mit einer Frist von einem Monat zum Ende
der Mindestlaufzeit gekündigt werden.
Wird das Abonnement nicht gekündigt, so verlängert es sich automatisch auf
unbestimmte Zeit und
kann dann jederzeit mit einer Frist von einem Monat gekündigt werden.
* Ich habe die umseitigen Geschäftsbedingungen für LR Partner, die beiliegenden
Liefer- und Zahlungsbedingungen, die Widerrufsbelehrung, Datenschutzerklärung
sowie den Verhaltenskodex für LR Partner
(www.lrworld.com/de/unsere-werte/verhaltenskodex) gelesen und stimme ihnen
zu.
* Ihr Vertragspartner: LR Health & Beauty Systems GmbH, Kruppstraße 55, 59227
Ahlen, Handelsregisternummer: HRB 10011 Amtsgericht Münster, Geschäftsführer:
Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen, Patrick Sostmann,
USt-IdNr.: DE 814331344, WEEE-Nr.: DE 47983902
* Bitte tragen Sie hier Ihre persönlichen Daten ein
* Antragssteller 1*
FrauHerr
* Vorname*
* Name*
* Geburtsdatum*
-Tag -MonatJahr
Datum
* Straße*
* Hausnummer*
* Zusatz
* PLZ*
* Ort*
* Telefonnummer
* Handynummer
* E-mail*
Confirmation Emailexample@example.com
* Antragssteller 2
FrauHerr
* Vorname
* Name
* Geburtsdatum
-Tag -MonatJahr
Datum
* Vermittler
* Partnernummer
* Name
* E-mail
example@example.com
* Ihr Vertragspartner: LR Health & Beauty Systems GmbH, Kruppstraße 55,
59227 Ahlen, Handelsregisternummer: HRB 10011 Amtsgericht Münster,
Geschäftsführer: Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen,
Patrick Sostmann, USt-IdNr.: DE 814331344, WEEE-Nr.: DE 47983902
* SEPA LASTSCHRIFTMANDAT
* SEPA-LASTSCHRIFTMANDAT
*
LR Health & Beauty Systems GmbH
Kruppstraße 55
59227 Ahlen
Deutschland Gläubiger-Identifikationsnummer DE56ZZZ00000433133
* Ich ermächtige (Wir ermächtigen) LR Health & Beauty Systems GmbH
widerruflich, Zahlungen von meinem (unserem) Konto mittels Lastschrift
einzuziehen. Zugleich weise ich mein (weisen wir unser) Kreditinstitut an,
die von LR Health & Beauty Systems GmbH auf mein (unser) Konto gezogenen
Lastschriften einzulösen.
Hinweis: Ich kann (Wir können) innerhalb von acht Wochen, beginnend mit
dem Belastungsdatum, die Erstattung des belasteten Betrages verlangen. Es
gelten dabei die mit meinem (unserem) Kreditinstitut vereinbarten
Bedingungen
* Vorname *
(Kontoinhaber/Antragssteller)
* Name*
(Kontoinhaber/Antragssteller)
* Postleitzahl*
* Ort*
* Straße*
* Hausnummer*
* Zusatz
* IBAN (mit Leerzeichen eingeben) *
(Ihre IBAN finden Sie auch auf Ihrem Kontoauszug)
* BIC
* Ort*
* Datum
-Tag -MonatJahr
Datum
* Unterschrift*
Löschen
* Ihr Vertragspartner: LR Health & Beauty Systems GmbH, Kruppstraße 55,
59227 Ahlen ·
Tel: +49 (0) 23 82/78 13-0 · www.LRworld.com
Bestellannahme: Tel: +49 (0) 23 82/70 60-81 · Fax: +49 (0) 23 82/70
60-905/906/907 · bestellung@LRworld.com
Service-Hotline: Tel: +49 (0) 23 82/70 60-72 · Fax: +49 (0) 23 82/70
60-311 · service@LRworld.com
HRB 10011 Amtsgericht Münster ·
Geschäftsführer: Dr. Andreas Laabs (CEO), Andreas Grootz, Thomas Heursen,
Patrick Sostmann
Bankverbindung: Commerzbank AG (BLZ 412 800 43) Konto-Nr. 560 112 500 ·
IBAN: DE15412800430560112500 · BIC: DRESDEFF413 · USt-IdNr.: DE814331344
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