Directory Direct Deposit Form
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DIRECTORY DEBIT ORDER FORM
Cedrus Internet Solutions (Pty) Ltd.
P O Box 1091
Hilton 3245
Tel: +27 (0)860 836 337
Fax: 033-3435882/53
Please print in block letters.
From: ________________________
 To: Cedrus Internet Solutions (Pty) Ltd.
Date:____/____/20__

Company name: _____________________________ E-mail Address: ____________________________

Postal Address: _________________________________________________________________________________________

Contact Person: _______________________ Telephone: ____________________ Fax: ____________________ Cell: ____________________

Account name:______________________________________________________Vat No: ______________________

Account number: |__||__||__||__||__||__||__||__||__||__||__||__| Branch name: __________________________

Branch code: |__||__||__||__||__||__| Account type: Current / Transmission / Savings / Other:_________

Bank: FNB: c Standard: c ABSA: c Nedbank: c Other: ___________


Company Description: ___________________________________________________________________

______________________________________________________________________________________

Countrywide: c / International: c


My agreement to subscribe to Cedrus Internet Solutions Pty LTD:

Annually: ZAR 480.00 |__|VAT Included.

First debit date within 14 days of fax date. I/We hereby request, "instruct" and authorise you to draw against my/our account with the above mentioned bank (or any other bank or branch to which I/we may transfer my/our account) the amount necessary for payment of the chosen subscriptions, any services used and any increases applied in respect of the above mentioned. All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally. I/We agree to pay any bank charges relating to this debit order instruction. This authority may be cancelled by me/us by giving you thirty days notice in writing, but I/we understand that I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank.

Signed at .............................................. on this ......... day of .........................../20.....


Authorised Signatory Name

___________________________________


Assisted by: (Where legally necessary)

___________________________________

__________________
Signature

_________________
Capacity

_________________
Signature

__________________
Capacity
Please fax this form and a used cheque (for identification purposes) to 033-3435882. Your Registration will be processed immediately on receipt of fax.