Slater: Electronic Debit Order Mandate

Electronic debit order mandate

Email Address*
Club (Slaters Gym Branch)
Fundraiser Name
Promo Code
Not compulsory
Company Name
Transaction
Are you paying for*
- Yourself
- Someone else
- Yourself and someone else
Main Member Details / The Person Paying:
Name*
First Last
ID or Passport Number*
Medical Aid Name
Medical Aid Number
Find address using Google Maps
Residential Address
Street Address Complex / Estate, Home Number & Internal Street City State / Province / Region ZIP / Postal Code Country
Find address using Google Maps
Work Address*
Company Name Complex / Estate, Home Number & Internal Street City State / Province / Region ZIP / Postal Code Country
Cell Number*
Work Number
Access Card Number
Contract:
One months written notice after expire.
Contract Period*
Month(s)
Contract Type*
Off-Peak
Prime Time
Corporate
V-Day Special
Discovery Vitality Membership Number
Joining Fee
Secondary Member Details:
Complete if you're applying for a secondary member.
Name
First Last
Cell Number
Children Details
Name ID Number Date of Birth Access Card Number
Work Number
Secondary Member Access Card Number
Promo Items (Free):
Access Card Normal
Price: R0.00 Quantity:
Access Card Premium
Price: R0.00 Quantity:
Water Bottle
Price: R0.00 Quantity:
Towel
Price: R0.00 Quantity:
Cap
Price: R0.00 Quantity:
Bag
Price: R0.00 Quantity:
Once-off Amount
Price: R0.00
Do you need any paid promo items?
- No
- Yes
Promo Items (Paid):
Access Card Normal
Price: R50.00 Quantity:
Access Card Premium
Price: R150.00 Quantity:
Water Bottle
Price: R10.00 Quantity:
Towel
Price: R80.00 Quantity:
Cap
Price: R80.00 Quantity:
Bag
Price: R100.00 Quantity:
Once-off Amount
Price: R0.00
Debit Order Details:
Monthly Amount
Price: R0.00
Start date for your contract*
Date Format: DD slash MM slash YYYY
Debit Day Every Month*
Payment Method:
Payment Method
Bank Account Details:
Type of Account*
Bank*
Branch Code*
Account Number*
Name of Bank Account Holder*
Credit Card Details:
Credit Card*

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Agreement:
Abbreviated short name as registered with the acquiring bank: SLATER
A once off annual levy of R88 will be charged in the Nov/Dec period to keep your membership the same for as long as you're a member. This means no yearly increases in fees.
If your debit date falls over a weekend or public holiday, you will be debited the day before the weekend or public holiday.
You first debit order will go through on the next upcoming day of your choice.
Refer to our contract reference number (“the Contract Reference Number”):
Reference*
Terms and Conditions*
DEBIT ORDER AUTHORISATION I/We hereby authorise Slater Health (hereinafter “the Company”) to issue and deliver payment instructions to my/our bank for collection against my/our above-mentioned account, provided that the aggregate of such instructions shall not exceed my/our financial obligations under the Membership Agreement. I/We acknowledge that such debit order transactions will be processed through a computerised payment system operated by South African banks, and that each transaction will be reflected on my/our bank statement. Receipt of this authorisation by the Company shall be deemed receipt by my/our bank. In the event that a scheduled debit order date falls on a non-processing day (including Sundays and public holidays), I/we consent to the payment being debited on the preceding business day. I/We further authorise the Company to utilise the tracking facility provided within the EDO (Early Debit Order) system at no additional cost to me/us. MANDATE I/We acknowledge that all payment instructions issued by the Company will be treated by my/our bank as if they were personally issued and authorised by me/us. CANCELLATION OF AUTHORISATION I/We understand and agree that while I/we may cancel this debit authorisation, such cancellation shall not constitute cancellation of the underlying Membership Agreement. I/We acknowledge that any amounts legally owing to the Company under this mandate and debited from my/our account are not eligible for reversal. Written notice of cancellation must be received no less than one calendar month prior to the intended cancellation date. The authorisation will remain in force on a month-to-month basis following expiry of the fixed period unless I/we provide a written cancellation notice at least twenty (20) business days prior to the next scheduled debit order. Cancellations must be submitted by email to cancellations@slatergyms.co.za or by completing the official cancellation form available at the gym. EARLY SETTLEMENT OPTION I/We may, at my/our discretion, settle outstanding obligations early by making direct payments. I/We confirm that the listed account complies with the Financial Intelligence Centre Act (“FICA”). ASSIGNMENT I/We acknowledge that this authorisation and mandate may be ceded or assigned to a third party, provided the underlying Membership Agreement is also ceded or assigned to such third party. PENALTY FEES In the event of a failed debit order, a penalty fee of R50.00 will be added to the following month’s account, payable by EFT or in person at any Slater Gym. This penalty will not be debited automatically from my/our bank account. In the event that a debit order processed through the EFT banking system is unsuccessful for any reason, the Company reserves the right to re-present the debit order on an alternative date, which may be up to one (1) day earlier or one (1) day later in the following month. The Customer remains responsible for ensuring that sufficient funds are available in the designated account on the due date and any alternative date of presentation. The Company shall not be liable for any bank charges, penalties, or fees incurred by the Customer as a result of an unsuccessful debit order.” I/We accept liability for all legal and collection costs incurred by the Company in recovering any outstanding amounts. This agreement is enforceable for the fixed period stated herein. The debit order reference will reflect as “SLATER” on my/our bank statement. CANCELLATION FEE This Agreement was duly completed and signed by me/us, and all information provided is accurate and true. I/We understand that I/we have the right to cancel this Agreement within five (5) days, excluding the day of signing, Saturdays, Sundays, and public holidays. Thereafter, early cancellation prior to the contract end date will incur a cancellation fee equivalent to 50% of the remaining balance of the Agreement. ANNUAL FEE I/We acknowledge and agree to an annual fee of R88.00, which will be debited during the November/December period. This fee secures the fixed membership rate for the following year, with no annual increase applied. MEDICAL FITNESS AND LIABILITY WAIVER I/We declare that I/we am/are medically and physically fit to engage in physical exercise. I/We acknowledge that the Company shall not be liable for any injury, loss, or damage sustained while using Club facilities. I/We confirm that the essential terms of this Agreement have been explained to me/us in a language that I/we understand, and that I/we understand the implications thereof. This Agreement constitutes the entire agreement between the parties, and no amendment, variation, or cancellation shall be of any force unless reduced to writing and signed by both parties.
Club Rules and Regulations*
All members shall comply with the Club’s rules and regulations, as prescribed by management. These may be amended from time to time and communicated either verbally or via signage within the Club premises. MEMBERSHIP ACCESS CARD Membership/Access Cards are non-transferable and may only be used by the registered member. No access shall be granted without the card. If a card is presented by a non-member, the card will be confiscated, and the member’s access may be suspended or terminated. A replacement fee may be charged for lost or stolen cards. If forgotten, access will only be permitted upon presentation of an ID or driver’s license, and only once every three (3) months. The Club reserves the right to deny access to any member who is in arrears or otherwise in breach of this Agreement. DRESS CODE AND HYGIENE Members must wear appropriate attire in line with the Club’s image and regulations. No topless training is permitted, including by male members. Members must use a personal towel during workouts and wipe equipment after use. AGE RESTRICTIONS - No person under 12 years may enter any training area. - No person under 16 years may use cardiovascular equipment (treadmills, rowers, cycles, etc.). Minors (12–18 years) may only train under specific membership plans and conditions, possibly requiring adult supervision. Childcare facilities are available at designated times, as advertised. MEDICAL AID MEMBERSHIPS Medical Aid memberships are valid only while an agreement exists between Slater Health and the respective Medical Aid provider and while payments are received. Such memberships are non-transferable and may be cancelled at the instruction of the respective Medical Aid. FREEZING OF MEMBERSHIPS Memberships may be frozen for medical or travel reasons only, for a minimum of one (1) month and maximum of three (3) months per 12-month cycle. Only prepaid memberships may be frozen. Debit order memberships are excluded. RECIPROCAL CLUB USAGE Members may access other Clubs within the Slater Group under the reciprocal agreement. Members are advised to confirm participating locations with reception. The Company does not guarantee access to third-party clubs using the Slater name and is not liable for any inconvenience caused by their unavailability. 17. DAMAGE TO CLUB PROPERTY Members shall be held liable for any damage caused—whether intentional or accidental—to Club property. 18. CLOSURE OR ALTERATION OF CLUB OPERATIONS The Club may permanently close or temporarily close for maintenance or upgrades. In the event of permanent closure, Slater Health reserves the right to provide an alternative facility within a 20 km radius. Operating hours may be adjusted at the discretion of Club Management. Equipment and class availability are subject to demand and may be modified or discontinued. 19. PRE-OPENING AGREEMENTS Slater Health may enter into agreements with prospective members for clubs under construction. While the Company endeavours to meet opening timelines, it does not guarantee any specific opening date. Memberships shall commence on the official opening date of the Club. 20. PERSONAL PROPERTY The Club shall not be held responsible for any loss, theft, or damage to personal property belonging to members, their dependents, guests, or any third party. By signing this Agreement, the member acknowledges full understanding and acceptance of the Terms and Conditions outlined above.
Signature*
Signature verified by Bank

E-Mandate

Electronic debit order mandates for your business.

(LS) #** SL002 – SLATER (ONLINE)

Main Member Details / The Person Paying:

Contract:

Secondary Member Details:

Promo Items (Free):

Promo Items (Paid):

Debit Order Details:

Payment Method:

Bank Account Details:

Credit Card Details:

Agreement:

Name	ID Number	Date of Birth	Access Card Number