The details of my account are as follows:
Type of account: Cheque (Current) ___ Savings account ___ Transmission account ____
Name of account holder:
Name of Bank:
|Amount in words|
I hereby request and authorise you to draw against my indicated account with the above mentioned bank (or any other bank or branch to which I may transfer my account) the above mentioned amount on the ____________ day of each and every month commencing on ______________. All such withdrawals from my bank account by you shall be treated as though they had been signed by me personally. Should this debit order not reach Blessed Gérard's Care Centre in time for processing on the above mentioned date, I hereby authorise Blessed Gérard's Care Centre to collect outstanding payments in the following month in which the debit order comes into operation.
This authority may be cancelled by me giving Blessed Gérard's Care Centre 30 (thirty) days notice in writing, sent by prepaid registered post.
Signature of account holder
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Page last updated on Tuesday, 15 January 2013 12:50:11