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Debit Order - Body and Mind - Natural, Alternative Health and Wellbeing Directory & Store

 



















 
 

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Body and Mind Debit Order Authorisation:
www.bodyandmind.co.za 
Tel: 031-4643247 / Fax: 031-4641092

Debit Order Authorisation:
 
Your Name:  
Contact Number:  
ID Number:  
Address:  
   
Email Address:  
   
Bank Name:  
Account Name  
Type of Account:  
Account Number:  
Branch Name:  
Branch Code:  
   
If you are paying by credit card :  
Expiry Date  
Master card or Visa  
CVC number  
Card number  
   
Amount to be debited  R


I certify that the above bank details are correct and I authorise Body & Mind to debit my account with my membership fee & other requested advertising fees on the 28th of every month. If these banking details have not been provided accurately, or if the details change at any time in the future & if I/we fail to notify Body & Mind of such changes, or if payment is not made in accordance with a Debit Order Instruction, the responsibility for payment will rest with me/us. Membership agreements are for a minimum of 6 Months and the onus is on the Customer to cancel, providing us as per the Debit Order form agreement, a 30 Day notice of such cancellation



All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us. This authority may only be cancelled by me/us giving 30 days' notice in writing.

Please NOTE: On your bank statement your debit's reference will be : PREMIUMCOLRF00000000(8digits)BODY******

Subscriptions are paid in advance.


Date:______________________________


 
__________________________ __________________________
Authorised Signatory Name of Signatory


 

 
 



















 
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The information and views expressed on this site are not necessarily the views of the Body & Mind staff. We are not
responsible or liable for any inaccuracy. We apologise if any offence is taken.

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