3DBusiness Debit Order

Debit order registration

Please provide all required details to register your debit order with us
Is this for a business?*
Submission Date*

YearMonthDay
E-mail Copy*
A copy of the agreement will be sent to this address
Personal Details
Name*

First NameMiddle NameLast Name
ID Number*
South African ID
Address*

Street Address

Street Address Line 2

CityProvince

Zip CodeCountry
Cell Number*
Work Number*
E-mail*
Director's Details
Director's Name*

First NameMiddle NameLast Name
Director's ID Number*
South African ID
Business Details
Business Name*
Business Address*

Street Address

Street Address Line 2

CityProvince

Zip CodeCountry
Business Registration Nr*
Business VAT Nr*
If applicable
Business Contact*

First NameLast Name
Business Number*
Business E-mail*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Account Details
Bank*
Account Nr*
Branch Code*
Type of account*
Debit amount*
Signature*

Authorised signature on account.
Abbreviated name as registered with the bank. To appear on your bank statement : 3DBusiness
I certify that the above details are correct and I authorise 3DBusiness Solutions to draw against my/our account, the payment due as reflected on my monthly statement. If these banking details have not been provided accurately, or if these details change at any time in the future and I/we fail to notify such changes, or if
payments are not made in accordance with the Debit Order instruction, the responsibility of payment will rest with me/us.

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 above mentioned 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:
On the __27__ day ("payment day") of each and every month commencing on
Date*

YearMonthDay
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 previous 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;

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.

MANDATE

I / We acknowledge that all payment instructions issued by you shall be reated by my/our above mentioned bank as if the instructions had been issued by me/us personally.

CANCELLATION

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 ntitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.

ASSIGNMENT

I / We acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

Receipt of this instruction by you shall be regarded as receipt there of by my/our bank.
Signed at*
City/Town
On this day:
Date*

YearMonthDay
Signature*

Duly authorised to sign this agreement
Please verify that you are human*
Should be Empty:

Debit order registration

Personal Details

Director's Details

Business Details

Bank Account Details