Term & Conditions of Debit Order Authorization
Any Debit Order sign-up online will be further authenticated either telephonically or by signature.
BANK DEBIT ORDER INSTRUCTION
Date : ______________________
Name (Debtor) : _____________________
Address : ________________________________________
Debit Amount : _____________
Contact No : _____________________
Commencement Date : _________
Customer Banking Details
The details of my/our account are as follows:
BANK : _______________________
BRANCH TOWN : _______________________
BRANCH NO. : _______________________
ACCOUNT NAME. : _______________________
ACCOUNT NO. : _______________________
TYPE OF A/C : ________________________
This signed Authority and Mandate refers to our contract as dated as on signature hereof (“the Agreement”). I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.
The individual payment instructions so authorised to be issued must be issued and delivered as follows
Date of Payment
i. On the _25th_ day (“payment day”) of each and every month commencing on [commencement date]. In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account;
Regularity of Payment
ii. Monthly; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less that the obligation due;
Withdrawals via Computerized system provided by South African Banks
I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally.
I / We agree that although this Authority and Mandate may be cancelled by me / us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I / We acknowledge that this Authority and Mandate has been ceded to Ultimate Growth CC t/a CloudSales and therefore reserves the right to contract any other South African approved & accredited providers of Debit Order facilitation services.
Signed at [location]_______________ on this [day]_____ day of [month]_________ 20___
SIGNATURE AS USED FOR SIGNING CHEQUES OR CREDIT CARD VOUCHERS
FOR OFFICE USE
AGREEMENT REFERENCE NUMBER
This Agreement reference number is: _____________________________________________________________