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RADIO PULPIT DEBIT ORDER
Online Debit Order Form
Title
*
Initials /First Name
*
Surname
*
Cell Number
*
E-Mail
*
Email
Other Contact Number
Birthday
*
DD
/
MM
/
YYYY
Address Line 1
Address Line 2
Suburb
City
Postal Code
DEBIT ORDER INFORMATION
Amount
*
R
Rand
Preferred Deduction Day
Please select
1
15
25
31
Frequency
*
Monthly
Yearly
Starting Date
*
DD
/
MM
/
YYYY
Banking Details
Bank
*
Please select
Absa Bank Limited - 632 005
African Bank - 430 000
Bidvest Bank - 679 000
Capitec Bank Limited - 470 010
Discovery - 679 000
First National Bank - 250 655
Investec Bank Limited - 580 105
Mercantile Bank Ltd - 450 905
Nedbank - 198 765
South African Post Office Ltd - 460 005
Standard Bank - 051 001
Tyme Bank - 678 910
Name of account holder
*
Account Type
*
Current
Savings
Account number
*
Please tick to automatically increase per year
Increase 10%
Increase 7%
Increase 5%
Authorisation
I hereby confirm
*
That I authorise Radio Pulpit to submit this debit order for collection
Please select
Yes
No
Signature
Clear
I hereby confirm
*
That the donor understand the following terms and conditions
Please select
Yes
No
Terms and Conditions
The client confirms that RADIO PULPIT is hereby authorized to do the deductions from the above mentioned bank account.
RADIO PULPIT and/or his personnel will not be authorized according to this agreement supply any information to a third party without pre authorization from the client.
In same context is the client not authorized according to this agreement to supply any information to a third party without authorization of RADIO PULPIT.
Unique ID
For any enquiries, please contact gospel@radiopulpit.co.za or (012) 334-1200.
