Paysoft Impact

Mdzanada Animal Clinic

Thank you for choosing to become a Paw Member or Sterisuppawter of the Mdzananda Animal Clinic. Please fill in the below form to set up your monthly debit order donation.

To find out more please visit www.mdzananda.co.za or email us on info@mdzananda.co.za.

Authorising person

I am signing on behalf of an organisation

I want a SARS Section 18A Tax Certificate

First names *

Last name *

Email address *

Contact number *

Company name *

Company registration number (Optional)

Company contact number (Optional)

Identification or passport number *

Identification type *

Country of issue *

Tax reference number (Optional)

Street names *

Suburb *

Town/City *

Province/State *

Postal code *

Birthday Date (for our pets to send you a birthday message) *

Banking details

Account number *

Account holder *

Bank name *

Account type *

Agreement

Start date *

Contract Duration *

Debit day *

Contract amount *

Annual increase %*

Legal agreement

Abbreviated short name as registered with the acquiring bank: MDZANANDA 
Refer to our contract reference number ("the Contract Reference Number").

I/We hereby authorise Mdzananda Animal Clinic to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number.

The individual payment instructions so authorised must be issued and delivered 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.

I/we agree that the first payment instruction will be issued and delivered on the "Start Date" and thereafter regularly on the "Debit Day" of each month.

If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or 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 canceled by me/us by giving you notice in writing of not less than the interval (as indicated in the previous clause) and sent by prepaid registered post or delivered to your address indicated above.

Mandate

I/we acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally.

Cancellation

I/we agree that although this authority and mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/we also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you.

Assignment

I/We 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.

Please sign in the box above

Mdzanada Animal Clinic

Authorising person

Authorising company

Banking details

Agreement