EmailMe Form - Membership Form for Body and Mind

Body and Mind Membership Agreement:

Abbrev. Name with bank: BODYNMIND

A. Authority: Given by (name of account holder)

First Last

ID. Number

Mobile Phone

### - ### - ####

Company Name (optional)

Contact Email address

Accounts Email address

Web Site (if you have one)

Who assisted you with becoming a member?

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What you get for your once off set up fee?

R500 Lets Get You Started

R1500 Level up

R2500 Ideal Choice

Lets Get You Started
Setup and design of your page on Body and Mind. List you under 4 Categories. Announce you on Social Media as a New Member.
R500

Level Up
Setup and design of your page on Body and Mind. List you under 5 Categories. Announce you on Social Media and WhatsApp group as a New Member. Email Mailshot to 1 group.
R1500

Ideal Choice
Setup and design of your page on Body and Mind. List you under 5 Categories. Announce you on Social Media and WhatsApp group as a New Member. Email Mailshot to 1 group YouTube Interview Marketing of video on Social media and WhatsApp group.
R2500

Monthly membership subscription R95 for all options

Amount R95-00 to be debited on the 28th of each month will be the membership fee on www.bodyandmind.co.za plus additional requested services for that month. *

I agree

Monthly marketing packages

Option 1
Subscription R95
Blog articles R55
Newsletter insert 1 province (normal price R250) R200
Whatsapp advert 1 province (normal price R150) R100

Total R450 per month

Option 2
Subscription R95
Blog Articles R55
Newsletter insert 1 province (normal price R250) R200
Whatsapp advert 1 province (normal price R150) R100
Social Media splash (normal price R300) R250

Total R700 per month

Option 3
Subscription R95
Blog Articles R55
Newsletter insert 1 province (normal price R250) R200
Whatsapp advert 1 province (normal price R150) R100
Social Media splash (normal price R300) R250
Mailshot 1 province (normal price R840) R750

Total R1450 per month *

R450

R700

R1450

No thank you.

Once you are a Body and Mind member you will be able to use our marketing services at a discounted rated in the future.
Mailshots, Friday Blasts, Social media splashes, web and graphic design and more....

Your Bank

Branch name and code

Account Number

Type of Account

This signed Authority and Mandate refers to our contract dated (“the Agreement”).

MM / DD / YYYY

I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned account at my/our above-mentioned Bank (or any other Bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement and commencing on the below date for a minimun of 6 months and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than one calendar month.

MM / DD / YYYY

Terms and Conditions:

The individual payment instructions so authorised to be issued must be issued and delivered as follows:
Monthly: In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the very next ordinary business day.

I/We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in Section E before the issuing of any payment instruction.

B. Mandate: I/We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the instructions have been issued by me/us personally.

I/We agree to pay any penalty bank charges relating to this debit order instruction.

C. Cancellation: I/We agree that although this Authority and Mandate may be cancelled by me/us with a 30 day notice of cancellation, such cancellation will not cancel the Agreement. 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.

D. 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, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party. *

I agree

E. Agreement Reference Number:

[First 10 letters of your name, NO SPACES] eg. BODYANDMIN (Total 10 characters)
*EFT Users may not use the tracking option and must exclude the option from their Authority and Mandate.

I agree that this serves as my digital signature as I enter into an agreement with Body and Mind to debit my account.
Please fill in your name

Signed at (area)

Dated

MM / DD / YYYY

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