Online Debit Order Form
Name & Surname
*
Naam
E-mail Address
*
Cellphone Number
*
Choose Your Option:
*
R1999 Yearly (Full Access on 2 Computers @ R796 p/m x 3 months)
R1999 Yearly (Full Access on 2 Computers @ R398 p/m x 6 months)
R1999 Yearly (Full Access on 2 Computers @ R199 p/m x 12 months)
R4999 LifeLong Access on 3 Computers @ R1996 p/m x 3 months
R4999 LifeLong Access on 3 Computers @ R998 p/m x 6 months
R4999 LifeLong Access on 3 Computers @ R499 p/m x 12 months
You chose:
R1996 (p/m) x
3 months
Your account will not be debited after 3 months.
Terms & Conditions
You chose:
R998 (p/m) x 6 months
Your account will not be debited after 6 months
Terms & Conditions
You chose:
R499 (p/m) x 12 months
Your account will not be debited after 12 months
Terms & Conditions
You chose;
R796 (p/m) x 3 months
Your account will not be debited after 3 months.
Terms & Conditions
You chose:
R398 (p/m) x 6 months
Your account will not be debited after 6 months
Terms & Conditions
You chose:
R199 (p/m) x 12 months
Your account will not be debited after 12 months
Terms & Conditions
Select the Debit Order Action Date
*
Please select
1st day of the month
15th day of the month
25th day of the month
30th day of the month
Account Type (Savings / Cheque)
*
Please select
Savings
Cheque
Bank Name
*
Please select
First National Bank (FNB)
Capitec
Standard Bank
ABSA
Nedbank
Ander
Name of Account Holder
Bank Code
*
Account Holder Name
*
Acount Number
*
Referral
Name of Person who Referred
Send
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