[vc_row row_type=”3″ blox_image=”9015″ align_center=”aligncenter” page_title=”page-title-x” full_container=”full-container” blox_dark=”true”][vc_column][distance type=”5″][distance type=”5″][distance][vc_column_text]

DEBIT ORDER FORM

[/vc_column_text][distance type=”4″][distance type=”5″][/vc_column][/vc_row][vc_row][vc_column][distance type=”2″][vc_column_text]

Complete your details required for the Monthly Debit Order Payment Option

Specify the preffered payment date that the debnit order should go off every month.

Once subitted – your first debit order will be deducted within the next 72 hours on which your project will start immediately.

[/vc_column_text][vc_column_text]

Javascript is disabled

Javascript is disabled on your browser. Please enable it in order to use this form.

Select Startup Plan*

Freelancer

Entrepreneur

Executive

First Name

Last Name

ID / Passport Number

Email Address

Cell Phone

Street Name

Area

Country

Province

Postal Code

Select Account Type*

Cheque

Savings

Money Market

Other

Bank Account Name

Bank Name

Account Number

Branch Name

Branch Code

Date of the month when you receive your salary

Copy of ID / Passport

Drag 'n Drop files here

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg,pdf | Min number of file: 1

Select Files

Proof of Address

Drag 'n Drop files here

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg,pdf | Min number of file: 1

Select Files

Bank Statement

Drag 'n Drop files here

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg,pdf | Min number of file: 1

Select Files

Debit Order Mandate

I/We hereby authorise you to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned 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 and will start on the starting as indicated in point B.

i. In the event that the payment day falls on a Sunday or recognized public holiday, the payment day will automatically be the very next ordinary business day. Furthermore, if there are insufficient funds in the (my) 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;

ii. monthly, bi-monthly, three monthly, six-monthly, annually, weekly, bi-weekly or once-off (delete which is not applicable), on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less than the obligation due.

I /We understand that the withdrawals hereby authorized will be processes through a computerized system provided by the Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which number must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in section D before the issuing of any payment instruction.

C. 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.

D. 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.

E. ASSIGNMENT

I/We acknowledge that this authority may be ceded 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.

Abbreviated name as it will appear on your bank statement every month: RE-STARTUP

I, the undersign hereby agree to accept our Debit Order Mandate. Your IP address will be stored in our database.

Signature

[/vc_column_text][vc_column_text]

By Submitting this form your agree to our Terms & Conditions

[/vc_column_text][/vc_column][/vc_row]

Debit Order Form

DEBIT ORDER FORM

Copy of ID / Passport

Proof of Address

Bank Statement

Debit Order Mandate

Signature

Your form has been submitted