Sharklife Membership Agreement and Mandate |
Member Details: |
| Name: {name:value} {last_name:value} |
| {email:label}: {email:value} |
| {tel_number:label}: {tel_number:value} |
| {country:label}: {country:value} |
| Agreement Commencement Date: {Commencement_Date:value} |
Membership Contribution Details: |
| Bank Direct Debit: |
| Donation Amount R: {bank_amount_Rands:value} |
| {bank_account_holder:label}: {bank_account_holder:value} |
| {bank_number:label}: {bank_number:value} |
| {branch_code:label}: {branch_code:value} |
| {bank_type:label}: {bank_type:value} |
| Credit Card Debit: |
| {cc_donation_amount:label}: {cc_donation_amount:value} |
| {name_card:label}: {name_card:value} |
| {card_number:label}: {card_number:value} |
| {expiry:label}: {expiry:value} |
| {card_type:label}: {card_type:value} |
Agreement: |
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1. This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). 2. 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). 2.1. On condition that the sum of such payment instructions will never exceed ("the Donation Amount") as stated above. 2.2. Commencing on the ("commencement date") and continuing until this Authority and Mandate is terminated by me / us by giving you notice no less than 14 ordinary working days to your email address indicated above. 2.3 The individual payment instructions will be on the last working day ("payment day") of each and every month. 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. 2.4 I / We understand that the withdrawals will be processed through the computerized system provided by the South African Banks. 2.5. I also understand that details of each withdrawal will be printed on my bank statement. 2.6. I understand that 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 2.7. I / We understand I/We shall not be entitled to any refund of amounts withdrawn while this authority was in force, if such amounts were legally owing to you. 3. 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. 4. 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. |
| Signed at {Signed_At:value} on this date {Signage_date:value} |
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Signature of Debtor:
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