Legacy Building Fund Debit Order Form

Thank you for considering a monthly donation to our legacy building fund!

Please complete the donation form as follows:

• Enter your home or business address,
• Then complete the banking details section to automatically generate a PDF debit order agreement for signature. 
• Please have the following documents ready for upload:
  • A pic/copy of your ID
  • A pic/copy of a "Proof of Bank account letter" This letter can be obtained via internet banking Or alternatively a  pic/copy of your bank statement (please feel free to block out the transactional data) 
  • For steps on how to get a "proof of bank account" letter, click HERE

We have partnered with Centric NetSolutions as our preferred payment gateway for this project. Once we have received your completed debit order form, they will debit your account as per your instruction.

Centric NetSolutions will notify you 7 days prior to your chosen collection date every month. You will be able to stop the debit order by clicking on the "Decline" button in this notification. 

Please note that clicking on "Decline" will stop the debit order for 1 month and we will get in touch with you. 

If you have any questions or need any support, please send an email to support@centricnetsolutions.co.za and we will get back to you within 2 business days.

Thank you! Your donation is for a total of  R{totalAmount} over {overHow} months. We will notify you 7 days prior to each transaction via email. Then we will debit your account with R{monthlyAmount} on the {preferredDay} day of every month as per your instruction contained herein

If you would prefer to complete and sign this agreement using pen and paper, you can click HERE to download a blank form. Once signed and completed, please email it to support@centricnetsolutions.co.za for processing. 

NB: If you are completing the document manually, please don't forget to also send us a copy of your ID and  proof of bank account letter along with your signed copy of the agreement.

But if you are happy to proceed elecrtronically Please click "NEXT" to sign the mandate agreement populated with the details you have entered above 

 

Donor Details:
Full Name/Company name (The Debtor):	{firstName}{middleName}{lastName}

Id number / Co reg:

{id_passport}

Address:

{addressLine44} {addressLine} {city} {state} {postal}

Cell Number:	{mobileNumber53}
Email Address:	{homeEmail}

 

Bank Details:
Account holder name:	{accountHolder}
Account number:	{accountNumber}
Bank name:	{bank}
Branch code:	{branchCode}
Account Type:	{accountType}

Please note that donations are only processed on business days. If your chosen collection day falls on a weekend or a holiday we will process your donation on the next available business day.

 

Service Provider Details:
Name:	Redemption Church	Reference:	REDEMPTION
Tel Number:	010 220 5454	Address:	10 Stoneridge Drive
			Greenstone Shopping Centre
Number:	{pcoId}		Greenstone Johannesburg, 1609

 

Definitions:

1.1 Amounts outstanding shall mean
1.1.1. total outstanding balance on my/our account, plus
1.1.2. any other amounts (“OTHER AMOUNTS”) that may become due, including but not limited to administration charges, interest, bank charges, penalties, collection charges, etc.
1.2 Amounts due shall mean
1.2.1. such an amount as may be due and payable to THE SERVICE PROVIDER on the 1st of each month, with a maximum amount not exceeding the total outstanding balance on my/our account plus (or inclusive of, however the case may be) OTHER AMOUNTS, this being the amount owing to the THE SERVICE PROVIDER now or in future
1.3 Penalties shall mean any amount that may be levied due to the non-payment or default of any amount due in terms of the Service Provider Standard Terms and Conditions.
 
2. I/we THE DEBTOR hereby instruct and authorise THE SERVICE PROVIDER to draw against my/our account with THE BANK (or any other bank or branch to which I/we may transfer my/our current account after the signature of this Agreement) or alternatively, if there are no banking details inserted on the face of this Agreement, then I/we authorise the Service Provider to draw against my credit card, the details of which have been tokenised via the relevant secure payment link clicked by the Debtor the monthly Amounts due,  plus any OTHER AMOUNTS should this be the case, on or before the Deduction Date, commencing on the date of first collection (DATE OF FIRST COLLECTION) and continuing until termination of this Agreement. All such withdrawals from my/our bank account or credit card by THE SERVICE PROVIDER shall be treated as though they had been signed and authorised and permitted by me/us (THE DEBTOR) personally.
 

3. I/we understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I/we also understand that details of each withdrawal will be printed on my/our bank/credit card statement or on an accompanying voucher.
4. I/we agree to pay any bank charges relating to this Collection instruction as negotiated between myself/ourselves and our bank.
5. Execution of this Agreement by THE SERVICE PROVIDER shall be regarded as receipt thereof by my/our bank (whichever it is or will be.)
6. I/we acknowledge that it remains my/our (THE DEBTOR’s) responsibility to ensure that all amounts outstanding are settled in full.
7. I/we acknowledge that all goods purchased (if applicable) will remain the property of the SERVICE PROVIDER and that ownership will only pass to the DEBTOR upon completion of complete payment.
8. This agreement shall terminate on the later of cancelation of this authority by THE DEBTOR or termination of the Agreement with the SERVICE PROVIDER. In the event that the DEBTOR wishes to terminate this authority, it shall provide a written notice of not less than 30 (thirty) days prior to such termination to the SERVICE PROVIDER.
9. I/we hereby consent to receiving communications by electronic mail (“email”) and/or short messaging service (“sms”).
10. I/we hereby choose abovementioned address as my Domicilium Citandi et Executandi.
11. I/we acknowledge that this collection authority may be ceded and assigned by the  SERVICE PROVIDER to a third party in the event that the collection mandate with the Service Provider (“Collection Mandate”)  is ceded or assigned to such same third party.
12. I/We acknowledge that Termination of the Collection Mandate does not have the automatic effect that the agreement with the Service provider is cancelled. The agreement between the customer and the service provider remains effective even although this mandate may be cancelled. I/We acknowledge that I/we are not entitled to any refund of payments/withdrawals while the Collection Mandate was still active, if such amounts were due and payable during such period.
13. I/We acknowledge that should a payment be due or an amount be drawn from my account on a non-business day (including public holidays) the payment or withdrawal shall be effected on the next ordinary business day.
 
Please note that all payments/withdrawals in terms of this authority will be reflected on your bank account as: REDEMPTION

THUS DONE AND SIGNED: