E-Mandate

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(DD) #41 MOI001 – MoiMooi

MoiMooi electronic membership application and agreement form

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Welcome to MoiMooi
MoiMooi has introduced its revolutionary concept of making beauty treatments for gents and ladies available to all. As a MoiMooi member, your small monthly fee ensures that you have access to up to FIVE free beauty treatments every month. You would usually pay up to R600-00 per treatment if you used a traditional beauty salon. We offer a one-stop beauty shop from hair to waxing to massages. Any of these treatments are free as a paying member.
MoiMooi is our salon service provider to our members. All of MoiMooi's therapists are professionally trained and accredited thus providing the level of service you would expect from a 5 star salon. MoiMooi uses only the best products available to ensure a therapeutic and relaxing experience.
To sign up for the MoiMooi Membership you will need to complete the following 2 easy steps:
1. Membership details
2. Payment details (authorize bank debit, securely, online) + eSignature

Membership details
Email Address*
Sales Agent
Referral Code
ID Type*
Country of Issue*
ID / Passport / Registration Number*
Name & Surname / Company Name*
Occupation*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Number*
Mobile Number*
Work Number*
If Company/CC, Name of Person(s) signing this*
Emergency Contact*
First Last
Emergency Contact Number*

Payment details
Coupon Code
Enter valid coupon code to apply discount
Coupon code applied.
About your membership and fees
Once-off Registration Fee: R200.00
Monthly Fee: R899.00
About your membership and fees
Once-off Registration Fee: R200.00
Monthly Fee: R699.00
About your membership and fees
Once-off Registration Fee: R200.00
Monthly Fee: R499.00
About your membership and fees
Monthly Fee: R499.00
And you may commence your treatments in the month that your registration fee is payable.
A welcome email will be sent to you, which will include your Membership number, information on how to book and contact details.
Account holder (debtor) information
Account Holder Name*
Bank*
Branch Code*
Account Number*
Account Type*
If "Other" please specify*
Collection instruction
Reference*
Interval
Is this limited to a fixed amount, or to debits due in future that may vary?
- Fixed amounts
- Variable amounts
Contract amount: R899.00
Contract amount: R699.00
Contract amount: R499.00
Contract Amount*
Continues indefinitely until cancelled by debtor?
- Yes
- No
Start Date*
Collection Date*
- 7th
- 15th
- 20th
- 25th
- Last Day
I/We, the above mentioned and undersigned, hereby authorise StratCol to collect by debit order from the above mentioned bank account, all amounts due in terms hereof and to pay same to the StratCol User below.
Terms of Agreement*
Agreement
I/We hereby authorise Stratcol to issue and deliver payment instructions to my/our banker for collection against my/our abovementioned account at my/our abovementioned bank.
STRATCOL USER NO: 1114776
STRATCOL USER NAME: BEE WITH US (PTY) LTD
STRATCOL ABBREVIATED NAME: GO
(this will be the name appearing on your Bank statement)
STRATCOL USER PHYSICAL ADDRESS:
264 Victoria Road
Woodstock
Cape Town
South Africa
The individual payment instructions so authorised to be issued, must be issued and delivered according to the abovementioned interval on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement.
The payment instructions so authorised to be issued, must carry a number, which number must be included in the said payment instruction and if provided to me/us should enable me/us to identify the agreement on my/our bank statement. The said number should be added to this form before the issuing of any payment instruction and communicated to me/us directly after having been completed by me/us.
I/We agree that the first payment instruction will be issued and delivered as per collection instruction.
If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I/We agree that the payment instruction may be debited against my/our account on the following or previous business day.
NAEDO
Allows for tracking of dates to match with flow of Credit at no additional cost to myself/ourselves. I/We authorise the originator to make us of the tracking facility as provided for in the EDO system at no additional cost to myself/ourselves.
Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled.
General Terms and Conditions
There is a five-day cooling-off period.
Bookings are essential and no walk-in treatments will be accommodated.
Dishonoured bookings will be recorded as redeemed.
Your membership entitles you up to five treatments per calendar month. Unused treatments will not be carried over.
The maximum treatment amount allowed is one per client per day (subject to appointment only).
Cancellation is subject to a written notice of 30 days prior to the intended date of cancellation subject to a cancellation fee.
Memberships are subject to an annual administration fee, which will be deducted in December.
There is a yearly membership subscription increase which takes affect on your anniversary month.
Payment dates on a Sunday or recognised South African public holiday , will automatically fall on the next ordinary business day, this is also applicable in December.
Where there are insufficient funds, we will re-present the instruction for payment as soon as the funds become available.
The Authority and Mandate may be terminated by the member, however, this does not cancel the Agreement (membership).
You will not be entitled to any refund of the amounts withdrawn while the Authority (debit order) was in place, if such amounts were legally owing by you.
The Authority and Mandate may be ceded or assigned to a third party only if the Agreement is also ceded to a third party.
Acknowledgements
I understand and acknowledge that my membership is subject to full terms and conditions which may be viewed at www.moimooi.com or I can obtain a copy by calling the MoiMooi Call Centre on 087 625 0626. MoiMooi may cancel my membership if I do not comply with my Contract or Spa Rules.
I hereby apply to become a member of MoiMooi as per the Terms and Conditions as set out on the Application Form and Debit Order Mandate.
I confirm that I/we are the person(s) with signature authority as registered with my/our bank.
- I agree to the Terms of Agreement
Signature as used for operating on the account
Signature verified by Bank

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