Debit Order Instructions

Debit Order - Please complete the debit order instrucitons below for the payment of your monthly hosting fee.

 
Account Holder:
Contact Number:
Email Address:
   
Name of Bank:
Branch Name:
Branch Code:
Account Number:
Type of Account:
Reference / Company Name:

Conditions

I/We hereby request, "instruct" and authorise Three Peaks to draw against my/our account with the above mentioned bank (or any other bank or branch to which I/we may transfer my/our account) the amount necessary for the monthly payment due in respect of the above mentioned agreement on the last day of each and every month for the amount of the hosting package selected by me/us. All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally. I/We agree to pay any penalty bank charges relating to this debit order instruction. Debit Orders will be on last day of each month.

 
Name:

Terms, Conditions & Indemnity

This authority may be cancelled by me/us by giving one calendar month's written notice, which can be sent by prepaid registered post, but I/we understand that I/We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. Interest on overdue payments will be charged at the Prime Rate levied by the Standard Bank of South Africa. I agree to the Terms and Conditions above and in the event of "handover" to pay attorney and own client cost, including collection commission.
I/We appoint as (domicilium citandi et exectandi) for the service of legal process, the physical address given above.
Rules & payment terms will be advised once enrolment has been finalized.

Accept Terms: You have to accept the Terms & Conditions
 


N.B By clicking on Submit you are agreeing to the terms and conditions.