Debit Order Form

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Name & Surname

Business Name

Mobile

Domain Name

Monthly Website Plan

Bank Name

Account Holder Name

Bank Account Number

Account Type

Day Of Debit

Select Website Options

Debit Order Acceptance

Do you authorise Website Rental to issue and deliver payment instructions to your Bank for collection against your Bank account on condition that the sum of such payment instruction will never exceed your obligations as agreed in your agreement? This method will commence effective from the activation of your Service, for the initial upfront charges and monthly subscription, on the 1st of each month and will continue monthly, or the Authority and Mandate is terminated by yourself by giving us notice of not less than one month. In the event that the payment day falls on a Sunday or recognised South African public holiday, the payment day will automatically be the very next ordinary business day. This Authority and Mandate may be cancelled by you however; such cancellation will not cancel this Agreement. You shall not be entitled to any refund of amounts which we may have withdrawn while this Authority was in force, if such amounts were legally owing to us. Abbreviated Name as Registered with the Bank: WEBSITEREN. I hereby confirm that I have read & understood the debit order mandate, and authorise Website Rental to draw on my account on the monthly billing date for the product that I have selected.

Debit Order Form

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