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Purchase Smartbrain WEB
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This field is for validation purposes and should be left unchanged.
Type of use of the program
(Required)
Select the type of use of the Smartbrain Program you intend to do by checking one of the following boxes:
Select an option
Professional use
Individual use
Rate
Indicate the rate you want to subscribe to
Month to month payment – 75 US dollars /month excluding VAT
One year payment in advance – 749 US dollars VAT excl.
Rate
Indicate the rate you want to subscribe to
Month to month payment – 20 US dollars/month excluding VAT
One year payment in advance – 199 US dollars VAT excl.
1.- DATA OF THE ENTITY OR PERSON WHO PURCHASES THE LICENSE
Name of entity
First and last name of contact person*
(Required)
Name
Last name
Country
(Required)
Spain
Argentina
Chile
Colombia
USA
Italy
Latvia
Mexico
Other
Specify country
(Required)
How did you get to know about us?
(Required)
Internet
Centro Breyna / Dr. Conrado Estol
Tienda Sensorial Argentina
Recommendation from a specialist
Recommendation from a relative or friend
Other
How did you get to know about us.?
(Required)
Internet search
Recommendation from a family association
Recommendation from a specialist
Recommendation from a relative or friend
Other
Specify other
(Required)
Address
(Required)
Full postal address
City
State
Zip code
Phone number
(Required)
Email address
(Required)
2.- PAYMENT
Payment method
(Required)
Select payment method
Funds transfer
Credit card
Funds transfer
I ill do the payment of the amount due via funds transfer, to the bank account of Smartbrain and Wellbeing, s.l. at Banc Sabadell
Account number:
IBAN: ES55 0081 0231 9200 0168 7770 – SWIFT/BIC: BSABESBBXXX
Credit card
(Required)
Indicate the details of the card with which you want to make the payment. Payment by card carries a management fee of 2% of the purchase amount.
Visa
Mastercard
Eurocard
Tarjeta 6000
JCB
Maestro
EDC
Clau
Card number
(Required)
Month of expiry
(Required)
January
February
March
April
May
June
July
August
September
October
November
December
Year of expiry
(Required)
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Name of card holder
(Required)
3.- INVOICING:
Invoice
No
Yes
Name of entity or person to be invoiced
(Required)
VAT number
(Required)
Address
(Required)
Zip code
(Required)
City
(Required)
Country
(Required)
Legal notice
(Required)
As soon as we receive this purchasing form of a license for using the Smartbrain Program correctly filled out, indicating the type of use foreseen and the desired fee, and we have confirmed the first payment, we will send you by e-mail the confirmation of registration in the program and the access keys to the program as administrator of the license. With these keys, which will already be active, you will be able to access the program immediately and use it to register your tutors, without limitation of number, who in turn will be able to register the users/patients, also without limitation of number. In compliance with the provisions of the legal regulations concerning the protection of personal data, we inform you that the personal data you provide when filling out this form will be collected in files owned by Smartbrain and Wellbeing s.l., with NIF: B87620928, domiciled in Calle Pico Balaitus 1 1C – 28035 Madrid, telephone: (+34) 609 792 358 and email: info@smartbrain.es; and that we will treat the information you provide in order to provide the requested service and perform the billing of the same. The data provided will be kept as long as the business relationship is maintained or for the years necessary to comply with legal obligations. The data will not be transferred to third parties except in cases where there is a legal obligation. You have the right to obtain confirmation as to whether Smartbrain and Wellbeing is processing your personal data, and therefore you have the right to access your personal data, rectify inaccurate data or request its deletion when the data is no longer necessary. We also request your authorization to provide you with information about our products and services related to those requested, and to retain you as a customer, by checking one of the following boxes:
Yes
No
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