Ref: Monthly hosting fee of domain http://www…………………………….. 

The details of my/our bank account are as follows:-

Bank ………………………………………..................................

Branch name & town ………………………………………...........

Branch number ....................................................................

Account number...................................................................

Account type - (Cheque / Transmission) - (No savings a/c)

Or Credit Card details:

Credit Card Type................................................................Owner name........................................

Credit Card number...............................................C V V number (3 digits on reverse side...........

Expiry date......................

I/We hereby request, “instruct” and authorise you to draw against my/our account with the abovementioned bank / credit card (or any other bank or branch or credit card to which I/we may transfer my/our account) the sum of R............................
(amount in words....................................................................................................................... ) for the amount necessary for payment of the monthly instalment/premium due on ………………day of each and every month commencing on ………………. , and continuing for a minimum of twelve months thereafter. All such withdrawals from my/our bank account/credit card by you shall be treated as though they had been signed by me/us personally.

I/We understand that failure to complete the twelve month term will negate validity of any "Free offers" received, example, domain registration, introduction web page design etc., and these will become payable.

I/We understand that the withdrawals hereby authorised will be processed by computer through a system known as the ACB Magnetic Taps Service, and I also understand that details of each withdrawal will be printed on my statement or on an accompanying voucher.

I/We agree to pay any bank charges relating to this debit order instruction.

This authority may be cancelled by me/us giving you thirty days notice in writing, sent by prepaid registered post, but I/we understand that I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be).

ASSIGNMENT: 
I/We acknowledge that the party hereby authorised to effect the drawing(s) against my/our account may not cede or assign any of its rights to any third party without my/our prior written consent and that I/we may not delegate any of my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorised party.

Signed at ………………………........ on this………………day of……………………………..20.......

.............…………………………........................................................................................…..
Signature(s) as used for signing cheques

…………………………………........
Assisted by (Capacity) (Where legally necessary)

NOTE: 
A cancelled cheque should be attached for bank identification purposes (Current Accounts only). 
The User may add to the above minimum requirements.

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