[paytium name="Connectz Compleet" description="Je maandelijkse betaling voor Connectz Compleet" button_label="Aanmelden"] [paytium_subscription interval="31 days" times="" /] [paytium_field type="name" label="Volledige naam" /] [paytium_field type="email" label="Email" required="true" /] [paytium_field type="text" label="Adres" required="true" /] [paytium_field type="text" label="Postcode" required="true" /] [paytium_field type="text" label="Plaatsnaam" required="true" /] [paytium_field type="text" label="IMEI-nummer" required="true" /] [paytium_field type="label" label="Abonnement €9,99" amount="9.99" /] [/paytium]