DEBIT ORDER SIGN-UP WANT TO AUTOMATE YOUR ACCOUNT? Please enable JavaScript in your browser to complete this form.1Personal Details2Financial Details3AuthorisationName of account holder *Contact number *Email address *Address *Address Line 1CityState / Province / RegionPostal CodeNextSelect your bank *ABSABidvest BankCapitecFNBNedbankStandard BankType of account *ChequeCurrentSavingsTransmissionOtherBranch name *Branch code *Account number *Debit order amount *Based on invoice (as per your package)Based on 30 day statementFixed AmountIf fixed amount, kindly indicate your debit order amount *Debit order date *20th25thLast day of the monthFirst day of the monthNextStandard Terms and Conditions *I/We accept the below terms and conditions *I/We hereby authorise Midnight Monkey (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my/our above mentioned account at my/our above mentioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number. The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement. I/we agree that the first payment instruction will be issued and delivered on the first effective date of submission of this contract and thereafter regularly on the date selected above of each month. A monthly invoice and/or statement of account clearly reflecting the amount and date of the payment instruction to be delivered shall be provided to the customer. If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the agreement have been paid or until this authority is cancelled by me/us by giving you notice in writing. B. 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. C. 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 also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you. D. 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.Authorised Signature *Clear SignatureCommentSubmit Please note all information submitted is treated a highly confidential and is securly transmitted by 128bit encrypted methods
