Debit Order

DEBIT ORDER
DETAILS OF DONOR
Name & Surname:*

First NameLast Name
ID Number:*
Email:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
DETAILS OF DONATION
Donation Amount (Rand value):*
BANKING DETAILS
Name & Surname of Account Holder*
Bank *
Account Number *
Branch Code *
Branch Name*
Account Type*
ALIVE TO GOD is hereby authorized to draw against the above-mentioned bank (or any bank, building society or branch to which the account may be transferred) the amount as indicated above. ALIVE TO GOD acknowledges that they may not cede or assign any of its rights to any third party without my/our written consent. Payment shall be made on the FIRST day of each month or the closest business day there to. The donor agrees to carry any fees charged by their bank for this debit order instruction. The donor may cancel this authority between himself/herself and ALIVE TO GOD at any time as this is a voluntary donation.
Signature*

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Should be Empty:

DEBIT ORDER