Debit Order FormName / Business Name *Name of contact person *Address *Street number and name, suburb and town / cityPostal code *Telephone number (H) Telephone number (W) Cellphone number *Language preference *AfrikaansEnglishIncome tax number of person donating Do you want to get involved in the debit order programme? *YesNo Account DetailsAccount Holder *Bank *Branch *Branch Code *Type of account ChequeSavingsTransmissionCredit cardAccount number Amount *Amount in words *Date on which account must be debited *1st17th Terms & Conditions I/We hereby confirm to pay any bank charges in connection with the Debit Order. I/We also confirm that there is no business relationship or agreement between Engo and myself. I/We understand that this debit order can be cancelled by myself at any time, with thirty days written notice. I/We acknowledge that the party hereby authorised to effect the drawing(s) against my/our account may not cede or assign any of its rights to any party without my/our prior consent and that I/We may not delegate any of our obligations in terms of this contract / authority to any party without prior written consent of the authorised party. Withdrawals authorised will be done by Bankserv system and receipts or statements will be shown on my account. By accepting these terms and conditions I/We authorise the organisation to proceed with the Debit Order.Email *ID / Reg Nr *To which sub-programme / house / centre should the money be allocated? * VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: