Authority and Mandate for payments Instruction: Electronic and Written Mandates

Abbreviated Name as Registered with the Bank: FURBALLS

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 the date as signed below and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above.

Please debit my account as follows:

and on the following date:

And I authorise for the debit order to start from:

In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day.

I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

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 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 I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.

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.

By completing and submitting the form above, I hereby agree to the below terms, and that the details provided are correct and you have my authorisation to transact against the above mentioned bank account.

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Terms and Conditions

I hereby instruct and authorise SAGE PAY, acting on behalf of Feeding the Furballs to draw against my account with the above mentioned bank, the amount specified above for the monthly donation due.

All such withdrawals from my bank account by you shall be treated as though they had been signed by me personally.

I agree to pay any penalty bank charges relating to this debit order instruction.

This authority may be cancelled by me by giving thirty days’ notice in writing, which can be sent by registered post, or by email. I understand that I shall not be entitled to any refund of amounts which have been withdrawn while this authority was in force.

The requirements for an authorization are that it needs to be in writing and in terms of the Electronic Communications and Transactions Act, the above form is constituted as an electronic data message, and therefore as legally binding as completing our standard printable form.