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Debit Order Authorization Details [Simplified & Explained]

Term & Conditions of Debit Order Authorization

 Any Debit Order sign-up online will be further authenticated either telephonically or by signature.


Customer Details

Date : ______________________

Name (Debtor) :      _____________________

Address :                  ________________________________________

Debit Amount :      _____________

Contact No :          _____________________

Commencement Date : _________


Customer Banking Details

Dear Sirs/Madams

The details of my/our account are as follows:

BANK :                    _______________________

BRANCH TOWN :      _______________________

BRANCH NO. :          _______________________

ACCOUNT NAME. :    _______________________

ACCOUNT NO. :        _______________________

TYPE OF A/C :                    ________________________

(savings,current, transmission)

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___




Assisted by:



This Agreement reference number is: _____________________________________________________________


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