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PERSONAL DETAILS

   

DEBIT ORDER DETAILS

 
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Offer Inclusive of VAT and the following:
•   Domain Registration (www.yourbusinessname.co.za)
•   4 Page Website Design
•   100 Email Accounts (yourname@yourbusinessname.co.za)
•   Flash or Slideshow Image Presentation
•   Search Engine Optimisation (google, yahoo etc.) SEO Analytics
•   Social Networking Links (facebook, twitter etc)
Customer name *
Trading name *
ID Number or Business Registration Number *
Email address *
Postal address *
Physical address
Suburb   Postal code
 
Telephone *   Fax
 
   
Information By completing this and accepting the terms and conditions, the customer/its representative hereby authorises Astral Media to debit from the account specified below:
 
Number 1 Monthly Service Fees (including any pro-rata amounts or any Service Fees charged monthly) or any such overdue Monthly Service Fees (including relevant interest and / or charges in terms of the Agreement) on the specified debit date of each calendar month; or
 
Number 2 Annual Service Fees or any such overdue Annual Services Fees (including relevant interest and / or charges in terms of the Agreement) on the specified debit date of each calendar month following the commencement of the Agreement or the Service and annually thereafter. This authority will remain in full force for the duration of the Agreement and any extensions thereof or whilst any amounts, including Service Fees remain outstanding.
 
Bank name *
Account holder *
Branch code *
Branch name *
Account number *
 
 
 
 
 
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