OUR LADY OF FATIMA DEBIT ORDER FORM
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PLEASE PRINT CLEARLY
Mr / Mrs / Miss ______________________________________________________
Address:______________________________________________________________
City_____________________ Prov__________________Postal Code_____________
Contact No___________________Email_____________________________________
My Child of Mary Offering: FVV1
R100 per month R200 per month R300 per month R500 per month Other: R ____________
BANK DEBIT ORDER INSTRUCTION
BANK:____________________________ BRANCH CODE:_______________ ACC NO:____________________________________
ACCOUNT HOLDERS NAME:_________________________________________________TYPE OF ACCOUNT__________________
Cheque/ Savings/Other
OR CREDIT CARD AUTHORITY:
CARD HOLDERS NAME:______________________________CARD NUMBER:___________________________________________
EXPIRY DATE:_________________ CARD TYPE: Master Visa
This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I hereby authorize you to issue and deliver payment
instructions to the bank for collection against my above mentioned account at my above mentioned bank on condition that the sum of such payment instructions will
never exceed my obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is
terminated by me by giving you notice in writing of no less than 20 ordinary working days. The individual payment instructions so authorized must be issued and
delivered on the agreed day of each month or the next business day. I understand that the withdrawals hereby authorized will be processed through a computerized
system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain
a number. I shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
MANDATE: I acknowledge that all payment instructions issued by you shall be treated by my above mentioned bank as if the instructions had been issued by me
personally. CANCELLATION: I agree that although this Authority and Mandate may be cancelled by me, such cancellation will not cancel the Agreement. 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entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. ASSIGNMENT: I
acknowledge that this Authority may be ceded to 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.
Date of Debit each Month: 1st 5th 15th 20th 25th 27th 30th
Commencement Date:_______________________________ Our abbreviated name with NETCASH is FAMILY ACT
Signature:__________________________________Date: _________________ (Required for either option above.)
YOUR CHILD OF MARY BENEFITS
1. Fr. Kevin Beaton will 2. You will receive 3. You will receive 4. Your name will be
offer a Holy Mass every this beautiful 40 x regular reports and framed on our Child of
Saturday morning for 50cm Fatima poster special updates. Mary Memorial Plaque
and a Child of Mary
you and your
lapel pin.
intentions.
