Debit Order Mandate

DEBIT ORDER AUTHORISATION FORM

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ALL THE BELOW NOTED DETAILS ARE AS PER THE SERVICE AGREEMENT ENTERED INTO BETWEEN THE GENSET DOCTOR (PTY) LTD AND CLIENT'S NAME ("USER")
Client's NameAs per the service agreement
Client's Registration NumberAs per the service agreement
Client's Address
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The Genset Doctor Account Number/s
Amount Including Vat
Debit Order Date
Telephone Number
Fax Number
TRADING AS THE GENSET DOCTOR TO DRAW AGAINST OUR BANK ACCOUNT WHEREVER IT MAY BE, THE AMOUNT(S) WHICH ARE DUE AND PAYABLE IN TERMS OF THE SERVICE AGREEMENT
Name Of Bank
Branch Name
Name Of Account Holder
Bank Account Number
Branch Code
Account Type
 
Agreement
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COMPULSORY DOCUMENTATION REQUIRED

  1. Cancelled Cheque or Stamped banking confirmation letter not older than (three) months
  2. Certified copy of ID documents of authorised signatories.

CANCELLATION

I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Service
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 I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such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

TRADE REFERENCE & CREDIT BUREAU CONSENT

The User hereby consents to The Genset Doctor or its cessionary/ies making enquiries into the User’s credit records and trade
references with any credit reference agency or any third party to confirm the details provided and confirm that this consent shall
apply in every respect to every director, shareholder, member and/or associate of the User. As signatory to this debit order
authorisation/amendment, I/we hereby indemnify The Genset Doctor or The Genset Doctor’s cessionary/ies against any claim that
may be made against The Genset Doctor or The Genset Doctor’s cessionary/ies by any director, shareholder, member and/or
associate of the User by virtue of this consent.