99 Club
Debit Order Form
Name
Initials
ID Number
Address
Cell Phone Number
Email
Bank Name
EG: FNB, ABSA, Capitec etc
Account Type
Current
Savings
Transmission
Account Number
Branch Code
Account Holder's Name
Eg: Joe Soap
Debit Order date during the month
Please select one
1st
15th
28th
Commencement Date
MM
/
DD
/
YYYY
Terms of Service
(1) I hereby declare that a monthly payment constitutes a donation to the Maritzburg College Foundation's 99 Campaign.
(2) I hereby authorise that R99 ONLY per month be debited from the nominated account.
(3) I undertake to ensure that there will always be sufficient funds available in the account to be debited.
(4) The Maritzburg College Foundation will not be held responsible or liable for any damages, costs or expenses arising from their lawful execution of this instruction.
I agree to the
terms of service
.
Date
MM
/
DD
/
YYYY
Signature of the Donor
Use your mouse or touch screen on your phone to sign
Clear
Where did you hear about this campaign?
Please let us know the primary platform which informed you of this campaign. That will really help us to understand our marketing efforts and further grow the intiative.
Facebook
Email
An Event
The Website
WhatsApp
Word of Mouth
Other
SUBMIT FORM
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