COVID 19 REPS MMA: DEBIT ORDER AUTHORISATION
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  • STRATCOL USER ID: 8751
    STRATCOL USER NAME: Reps Fitness
    STARTCOL ABBREVIATED NAME: REPSSTUDIO
    STRATCOL USER PHYSICAL ADDRESS:
    2 Melkhout ave, Kuilsrivier, W/Cape, 7580

  • (PLEASE DO NOT AUTOFILL) ACCOUNT HOLDER (DEBTOR) INFORMATION:

  • COLLECTION INSTRUCTION

    Please select the preferred interval of payment
  • Once-off transaction:

    THIS IS USED FOR JOINING FEES AND OR PRO RATA FEES IN THE EVENT WHERE IT WILL ONLY BE DRAWN FROM YOUR ACCOUNT ONCE OFF AND NOT MONTHLY. THE DATE FOR THIS AMOUNT, IF APPLICABLE, WILL BE DECIDED BY THE GYM.
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  • R .
  • Recurring transactions:

    THIS IS YOUR MONTHLY FEE THAT WILL BE DRAWN EVERY MONTH FOR YOUR GYM FEES WITH EITHER THE 25th, 26th, 27th, 28th, 29th, 30th, 31st in advance for the next month, or 1st, 2nd, 3rd, 4th, 5th or the 15th of the specific month.
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  • R .
  • (1-31)
  • (%)
  • I/ We, the above mentioned and undersigned, hereby authorize STRATCOL to collect by debit order from the above mentioned bank account, all amounts due in terms hereof and to pay same to the STRATCOL User above.

    (I confirm that I/ we are the person(s) with signature authority as registered with my/ our bank).
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  • Agreement

    I/we hereby authorise STRATCOL to issue and deliver payment instructions to my / our banker for collection against my/our abovementioned account at my/our abovementioned bank.

    The individual payment instructions so authorised to be issued, must be issued and delivered according to the abovementioned interval 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.

    The payment instructions so authorised to be issued, must carry a number, which number must be included in the said payment instruction and if provided to me / us should enable me / us to identify the agreement on my / our bank statement. The said number should be added to this form on page 1 under client reference number, before the issuing of any payment instruction and communicated to me / us directly after having been completed by me / us.

    I/we agree that the first payment instruction will be issued and delivered as per collection instruction. In the event of the relevant account not having sufficient cleared funds to meet any debit, I am aware that a unpaid fee will be debited against my account by the band and an additional unpaid fee will be charged by Sample relating to the return of the debit. I accept the
    responsibility to ensure sufficient cleared and available funds to the minimum of the limit above (or as amended from time to time).

    If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I / We agree that the payment instruction may be debited against my / our account on the following or previous business day.
  • MANDATE

    I / we acknowledge that all payment instructions issued by the Stratcol User 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 the Stratcol User. I agree that i will pay an additional R50 for unpaids due to insufficient funds and can pay up to R350 for unauthorized reversed debit orders and that these penalties will be deducted from our account in this instance which we will need to recover from you. Reps gym have a strictly seven (7) day period on all outstanding accounts before legal hand over fees will be levied to you in the case of no comunication and payment.
  • 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.
  • Enter place of signature
  • What day is this?
  • What month is it?
  • What year is it?
  • Signature (1)
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  • Disclaimer

    I, hereby declare that all of the above information is correct and I have read and understood all of the terms and conditions. I hereby accept full responsibility for the settlement of the account as and when it becomes due.
    PLEASE NOTE THAT YOU WILL BE TAKEN TO COMMUNICATE WITH A REPRESENTATIVE FROM THE GYM VIA WHATS APP ON SUBMISSION OF THIS FORM. PLEASE FEEL FREE TO ASK SHOULD YOU REQUIRE ANY MORE INFORMATION OR IF YOU SIMPLY WANT TO INTRODUCE YOURSELF, HOWEVER YOU ARE NOT AT ALL OBLIGED TO DO SO.