Debit Order Form – Salon Product

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Debit Order Form

Salon Product / Debit Order Form

Company Registered Name:
Salon Product Distribution (Pty) Ltd
Abbreviated Name with bank:
SALONP
Registration Number:
2020/833292/07
Beneficiary’s Address:
14 Macinnes Road, Glenferness, Kyalami, 2191
A. Authority
Name of account holder to debit:*
First Last
ID Number / Company Reg No.*
Contact Name: *
First Last
Address:*
Address Line 1 Address Line 2 City Province Code
Cellphone Number:*
Work Number:*
Bank:*
Branch Code:*
Account Number:*
Type of Account:*
Debit order date:
1st of the month
Fixed amount to be deducted monthly
R99
Amount to be deducted:
As per Invoice / Contract
Capped Amount:
This signed Authority and Mandate refers to our contract dated (“the Agreement”).
I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned account at my/our above-mentioned Bank (or any other Bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement and commencing on and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing either via Whatsapp or email of not less than 20 ordinary working days.
If 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.
I/We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. Details of this are in section E.
B. Mandate
I/We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the instructions have been issued by me/us personally.
I/We agree to pay any penalty bank charges relating to this debit order instruction.
C. Cancellation
I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.
D. Assignment
I/We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.
Signed at https://salonproduct.co.za on
Signature (Account holder on the bank account)*
E. Agreement Reference Number
This Agreement reference number for debtor is SALONP Abbreviated Name

Debit Order Form

Company Registered Name:

Abbreviated Name with bank:

Registration Number:

Beneficiary’s Address:

A. Authority

Debit order date:

Fixed amount to be deducted monthly

Amount to be deducted:

B. Mandate

C. Cancellation

D. Assignment

E. Agreement Reference Number

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