I hereby authorise FEBA Radio SA to draw against my account monthly, until cancelled by me:

Amount in R (in words)
Commencing (month of first debit)
 
 
[Debits take place around the 2nd of every month. To avoid charges, please give us two weeks' notice to stop a debit order]
   
I wish to add 10% annually:
   
Bank
Type of Account
Branch Code
Account Number
ID Number:
 
   
Title:
Name & Surname:
Postal Address:
Code:
Telephone:
Church / Organisation: