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Debit Order Form
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March 12 2025
nnsadmin
Debit Order Form
Authorised by (Name of Account Holder)
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Physical Address
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Date
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I / We hereby authorise Netcash (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned 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.
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I agree
Bank Name
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Branch and Code
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Account Number
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Type of Account
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select account type
Current (cheque)
Savings
Transmission
Debit Order Amount
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Reference Number: (Quote or Invoice number)
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Date of 1st debit order
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and thereafter regularly on the (enter day, first or last)of each month.
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B. MANDATE
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I/we acknowledge that all payment instructions issued by you will be treated by my/our abovementioned bank as if the instructions had been issued by me/ us personally
I agree
C. CANCELLATION
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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 I/we also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you
I agree
Submit
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