E-Mandate

Electronic debit order mandates for your business.

(LS) #42 GPA002 – GREENPEACE SOURCE

Greenpeace Africa relies on donations from generous individuals to carry out our work. By becoming a donor you'll join Greenpeace in our work to protect our precious planet and find the solutions we need to our most important environmental issues.It's the support of caring people like you that gives us the courage and the resources to take on the goliaths in our society -- those who would otherwise recklessly plunder our oceans, tear down forests, and pollute our precious rivers.In order to remain independent, we do not accept funding from governments, corporations or political parties.We can't do it without your help. Please support us today.
Your Personal Details:
Name*
Title First Last
Address*
Country*
Email Address*
Phone Number
ID Type*
- RSA ID
- Other
ID Number*
Other ID*
Date of Birth
Date Format: MM slash DD slash YYYY
Profession
Designation
Your Bank Account Details:
Bank*
Branch code*
Account number*
Type of account*
Agreement:
Abbreviated short name as registered with the acquiring bank: GREENPEACE
Please note your donor reference number:
Reference*
I want to donate*
Your monthly donation amount*
- R5000
- R10 000
- R15 000
Your monthly donation amount*
- R180
- R200
- R300
- R500
- R800
- R1000
Your donation amount*
R600 minimum
Start date for first debit to my account*
Date Format: DD slash MM slash YYYY
and thereafter regularly on the:
Monthly debit order day*
of each month.
I hereby authorise you to issue and deliver payment instructions to your banker for collection against my above mentioned account at my above mentioned bank (or any other bank or branch to which I may transfer my account) on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the donation agreement and commencing on the payment date as selected above and continuing until this authority and mandate is terminated by me by giving you notice in writing of not less than 20 ordinary working days, and sent by email.
I understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. I understand that my bank will apply charges at their ruling rates for unmet transactions. I also understand that any banking fees incurred by GREENPEACE Africa may be recovered of unmet transactions.
If the payment day falls on a Sunday or recognised South African public holiday, the payment will automatically be processed the previous ordinary business day.
I authorise the originator to make use of the tracking facility as provided for in the EDO system at no additional cost to myself.
ASSIGNMENT
I 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.
ESCALATION
Not withstanding the current terms of agreement. I hereby authorise Greenpeace Environmental Organisation to effect an annual escalation of 10% on my monthly debit order against my above mentioned bank.
CANCELLATION
I agree that although this Authority and Mandate may be cancelled by me, I shall not be entitled to any refunds of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. I understand that cancellations may only take effect a month later.
Signature*
Signature verified by Bank
Source

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Your Personal Details:

Your Bank Account Details:

Agreement:

ASSIGNMENT

ESCALATION

CANCELLATION