(DD) #** ATT001 – ATTSA

Electronic debit order mandate.
  • Authority given by:

  • Bank account details:

  • Agreement:

  • Please enter a number greater than or equal to 50.
  • I/we agree that the first payment instruction will be issued and delivered on:
  • Date Format: DD slash MM slash YYYY
  • and thereafter regularly on the:
  • Signature verified by Bank