E3 ONLINE SUBSCRIPTION
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| Name and
Surname/Company Name: |
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| ID
Number/ Company Registration |
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| Postal
Address: |
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| Physical
Address: |
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| Phone
(H): |
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| Phone
(W): |
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| Fax
(for application forms): |
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| Preferred E-mail Address: |
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| Alternative E-mail Address: |
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DEBIT ORDER INSTRUCTION:
To: E3 Solutions Internet
Dear Sirs
The details of my bank account are as follows:
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| Bank: |
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| Branch
Name and Town: |
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| Branch
Code: |
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| Account Holder: |
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| Account
Number: |
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| Type of
Account: |
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Please call us for customised
option eg. ADSL over 10GB Capping, onsite firewalling/servers,
All our POP3 Mailboxes come with up to 5 aliases as standard.
Catchall accounts also available at extra cost.
All mail is SPAM and VIRUS filtered.
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Subscription Options |
| ADSL |
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| DIALUP |
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One-Price LineSpeed Option:
None
384Kb/s
up
to 512Kb/s
up
to 4096Kb/s |
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| Price:
R |
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| Hosting
Package: |
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| Hosting
Package Price: R |
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| Hosting
Extra's: |
| Webstats (free): |
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| Front
Page Extensions (R100 pm): |
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| TOTAL: R |
per
month |
| Contract Period: (1/12/24) |
month(s) |
I/we hereby request , "instruct"
and authorise you to draw against my/our account with the above-mentioned
bank (or any other bank or branch to which I/we may transfer my/our account)
the sum of
R
,
"the amount necessary for payment of the monthly/yearly installment due in
respect of the above-mentioned agreement" on the
day of
each and every month/year commencing
on the
of
and
continuing (as the case may be).
All such withdrawals from my/our bank account by you shall be treated as
though they had been signed by me/us personally.
I/We understand that the withdrawals hereby authorised will be processed by
computer through a system known as the ACB Magnetic Tape Service, and I also
understand that details of each withdrawal will be printed on my bank
statement or on an accompanying voucher.
I/We agree to pay any bank charges relating to this debit order instruction.
This authority may be cancelled by me/us by giving you thirty days notice in writing
unless the remaining contract term exceeds 30 days
whereupon the remaining contract period is the notice period.
Cancellation is to be sent by prepaid registered post, but I/we understand
that I/we shall not be entitled to any refund of amounts which you have
withdrawn while this authority was in force if such amounts were legally
owing to you. Receipt of this instruction by you shall be registered as
receipt thereof by my/our bank (whichever it is or will be). |
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ADSL
