(DD) #44 NGF001 – NORMAN GOODFELLOWS

Your Order
Chosen Palette*
Your Details:
Title
Name*
Firstname Surname
ID Number*
Cellphone Number*
Home Number
Work Number
Email Address*
Delivery Information:
Recipient Name
Shipping Address*
- Physical Address
- Postal Address
Where would you prefer your palette be delivered?
Physical Address*
No. and Street Suburb City Province ZIP / Postal Code

We recommend you use a business address where possible.
Postal Address*
P.O. Box Suburb City Province ZIP / Postal Code
Additional Delivery Note
For Instance - Ask for Sue she can sign for this or hoot at gate. Leave blank if nothing.
Payment Method:
Pay Using?*
Coupon?
If you have a coupon code, please enter it now.
Credit Card Details:
Credit Card*

American Express
Discover
MasterCard
Visa
JCB
Maestro
Card Number Expiration Date Security Code Cardholder Name
Bank Account Details:
Account Holder*
Bank*
Branch Code*
Account Number*
Account Type
Agreement:
Abbreviated short name as registered with the acquiring bank: NGF
Refer to our contract reference number (“the Contract Reference Number”):
Reference*
I hereby authorise Norman Goodfellows (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my abovementioned account at my abovementioned bank on condition that the sum of such payment instructions will not differ from my obligations as agreed to in the Contract Reference Number.
The individual payment instructions so authorised must be issued and delivered 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.
I agree that the first payment instruction will be issued and delivered on 19/02/2020, unless this date falls between the 1st and 16th in which case I will be billed the 1st of the next month and thereafter regularly on the 1st of each subsequent month for the amount of:
R899 per month until you cancel
R599 per month until you cancel
If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is canceled by me/us by giving you notice in writing of not less than the interval (as indicated in the previous clause) and sent by prepaid registered post or delivered to your address indicated above.
Mandate
I/we acknowledge that all payment instructions issued by you 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 you.
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.
Signature*
Signature verified by Bank

DISCONNECTED: CHECK INTERNET CONNECTION