Download Report

DEBIT ORDER INSTRUCTION
FROM: (NAME OF RESIDENT)
…………………………………………..
OF:
…………………………………………..
(ADDRESS)
…………………………………………..
(PHONE)
…………………………………………..
(CELL)
…………………………………………..
…………………………………………..
DATE:
TO:
Devonshire Park Estate
P O Box 97571
PETERVALE
2151
Dear Sirs
I agree to you debiting my bank account as detailed below for the collection of the monthly running costs of the Devonshire
Park Estate Access Monitoring initiative. I understand that this charge is R390 per month from 1 February 2015. I agree
that this amount may be altered from time to time upon at least 30 days’ notice. The details of my bank account are as
follows:
BANK :
__________________________
BRANCH CODE: __________________________
TYPE OF ACCOUNT:
BRANCH:
________________________________
ACCOUNT NO: ________________________________
(Current(Cheque)/Savings/Transmission)
________________________________
I/WE hereby request, instruct and authorise you to draw against my account with the above-mentioned bank (or any other
bank or branch to which I may transfer my account) the sum of R390.00 (three hundred and ninety Rand), being the amount
necessary for payment of the monthly instalment due in respect of the above-mentioned agreement on the 1st day of each
month and continuing unless and until this authority is withdrawn by me in writing. All such withdrawals from my bank
account by you shall be treated as though they had been signed by me personally.
I understand that the withdrawals hereby authorised will be processed by computer through a system known as the ACB
Magnetic Tape Service, and l also understand that details of each withdrawal will be printed on my bank 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 by giving you thirty days notice in writing, but I understand that I 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to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to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)
Signed at …………………………… on this the………… day of……………………………….. 20 .
………………………………………………………..
SIGNATURE AS USED FOR SIGNING CHEQUES
A cancelled cheque can be attached for bank identification purposes. (Current Account only)
PLEASE SCAN AND EMAIL THE COMPLETED DOCUMENT TO YOUR STREET CAPTAIN
[email protected] (Cambridge Road)