BANK DEBIT ORDER INSTRUCTION / CREDIT CARD AUTHORITY

BANK DEBIT ORDER INSTRUCTION / CREDIT CARD AUTHORITY

HIGHWAY AQZ AQUATICS (Pty) LTD2015/135405/07
- Name Of Account Holder
  
  First NameLast Name
- Name Of Swimmer
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Debit Amount:
- Debit Order Date
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate on which the debit order starts and repeats each month.
- Bank
- Branch Code
- Branch Town
- Account Holders Name
- Account Number
- Account Type
- Abbreviated Shortname to be used: AQUAZONE
  
  Debit Order Authority and Mandate
  
  This signed Authority and Mandate refers to our contract dated as at the date of signature hereof (“the Agreement”).
  
  I/We hereby authorise you to issue and deliver payment instructions to my/our bank for collection against my/our above-mentioned account at the above-mentioned bank (or any other bank or branch to which I/we may transfer my/our account), on condition that the amount of such payment instructions will never exceed my/our obligations as agreed to in terms of the Agreement.
  
  Payment instructions shall commence on the agreed commencement date and shall continue until this Authority and Mandate is terminated by me/us by providing one (1) full calendar month’s written notice.
  
  Cancellation received on or before the 5th day of the notice month will result in no debit order or invoice being raised for the following month.
  Cancellations received after the 5th will result in one additional month being charged.
  
  I/We further acknowledge and agree that the annual Club Membership Fee is payable once every twelve (12) months from the date of enrolment and authorise Aquazone Swim Club to deduct this fee annually via debit order, together with or separate from the monthly swim fee, as applicable.
- On the e.g. 1st* day (“payment day”) of each and every month commencing on 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;
- Tick the appropriate box
- 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 treated 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 entitled 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.
- Signed at place* on this e.g. 4th* day of month* year*
- Initials and Surname
  Example of Initials and Surname: JJ Doe
- Signature
- Assisted by:
  
  Fiona CO Aquazone
- Should be Empty: