Stepping Stone: Debit Order Mandate

Welcome to the Club 2000 where you now stand a chance of winning one of SEVEN cash prizes monthly!
1st: R20 000
2nd: R2000
3rd: R1000
4 prizes of R500 each
RULES
1. Prices are allocated on a lucky draw basis each month.
2. Monthly draws take place during the 2nd week of the following month.
3. The judges’ decision is final and no correspondence will be entered into.
4. Winners agree to their names being published.
5. The club is limited to 2000 subscriptions in total per club.
6. As the draw is under the supervision of independent auditors, Stepping Stone Hospice Alberton’s staff,volunteers and their family members are welcome to join.
7. All unclaimed prices will be forfeited within 6 months of draw.
8. All proceeds from the club are used to care for the terminally ill in the greater Alberton area of Ekurhuleni.
I would like to join and donate to
Authority given by:
Name*
First Last
ID Type*
- RSA ID
- Other
ID Number*
Other ID*
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Cellphone Number*
Home Number
Work Number
Payment Method
Bank account details:
Account holder
Bank*
Branch code*
Account number*
Type of account*
Credit card details:
Credit Card*

Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Agreement:
Abbreviated short name as registered with the acquiring bank: STEPSTONE
Refer to our contract reference number (“the Contract Reference Number”):
Reference*
Contract amount*
- R50 per month = 1 lucky number per month
- R100 per month = 2 lucky numbers per month
- R150 per month = 3 lucky numbers per month
- R200 per month = 4 lucky numbers per month
Start date for first debit to my account*
Date Format: DD slash MM slash YYYY
and thereafter regularly on the:
Monthly debit order day*
Terms of agreement
Beneficiary’s address: Stepping Stone Hospice, 15 Heidelberg Rd, Cnr Ascor Rd and New Market Park, Alberton I hereby authorise you to issue and deliver payment instructions to your banker for collection against my above mentioned account at my above mentioned bank (or any other bank or branch to which I may transfer my account) on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the donation agreement and commencing on the payment date as selected above and continuing until this authority and mandate is terminated by me by giving you notice in writing of not less than 20 ordinary working days, and sent by email. I understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. I understand that my bank will apply charges at their ruling rates for unmet transactions. I also understand that any banking fees incurred by Stepping Stone Hospice may be recovered of unmet transactions. If the payment day falls on a Sunday or recognised South African public holiday, the payment will automatically be processed the previous ordinary business day. I authorise the originator to make use of the tracking facility as provided for in the EDO system at no additional cost to myself. ASSIGNMENT I 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. CANCELLATION I agree that although this Authority and Mandate may be cancelled by me, I shall not be entitled to any refunds of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. I understand that cancellations may only take effect a month later.
Signature*
Signature verified by Bank

E-Mandate

Electronic debit order mandates for your business.

(LS) #43 SSH002 – STEPPING STONE

Authority given by:

Bank account details:

Credit card details:

Agreement: