Debit Order
|
- Click on the print icon at the bottom of the page and print out two copies of the page.
- Complete the form, sign it and the please fax or post it to us.
- Fax: 0866 406 983 (Only within SA), alternatively +27 11 396-1302
- Postal Address: PO Box 10170, Aston Manor, 1630, South Africa
- Please keep the other copy in a safe place for reference purposes.
- Please close this window once you have printed the form.
|
| Title |
_______________ |
Initials |
_______________ |
Surname |
__________________________ |
| Address |
_____________________________________________________________________________ |
| Postal Code |
_______________ |
|
| Tel (W/H) |
_______________ |
Fax |
_______________ |
| Cell |
_______________ |
E-mail |
__________________________________ |
| |
|
Bank Details of Contributor |
| Bank |
___________________________________________ |
| Branch Name |
_________________________ |
Branch Code |
_______________ |
| Account No |
_________________________ |
Account Type |
_______________ |
| |
|
Beneficiary: |
| SAAWE (South
African Action for World Evangelization) |
| ABSA
0020-167-513 |
| In favour of |
_________________________________________________________________________ |
| |
| I/We request
and authoirse you to debit my/our account at the bank/branch mentioned
above (or any other bank/branch to which I/we may transfer the account)
with the amount of R _______________ |
|
(amount in words)
______________________________________________________________________________________ |
| on the first
day of the month, commencing on __________________________(month
and year). |
| I/We request
and authoirse you to increase this amount annually with the amount of R _______________
or
_______ %. |
| I/We agree to
pay the banking costs of this debit order. |
| |
|
_________________________________________ |
|
__________________________________ |
| Signature(s) of
Plenipotentiary(ies) |
|
Date |
|
|
