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4. Debit Order Authorisation (Please attach a copy of a cancelled Cheque or Bank Statement header)
Account Holder
Bank
Code
Branch
Account Number
Current
Account Type
Savings
Transmission
1st Day of the Month
Payment Date
I / We hereby acknowledge acceptance of the above services and costs, and authorise WT24/7 or it’s cessionary in terms of what the VEHICLE TRACKING &
GSM SERVICES CONTRACT to draw against my/ our banking account (details indicated above), varying amount
Name
Date
D
D
M
M
Y
Y
D
D
M
M
Y
Y
Signature
Name
Date
Signature
5. Declaration
The subscriber warrants that the above information is true and correct and, by his/her /their signature acknowledges entering into a VEHICLE TRACKING &
GSM SERVICES AGREEMENT with WT24/7, upon WT24/7’s standard Terms and Conditions as provided for in this contract.
Name
Date
D
D
M
M
Y
Y
D
D
M
M
Y
Y
Signature
Name
Date
Signature
For Office Use Only
Subscriber Account No.
Fitment Centre Name
Invoice No.
Installation Certificate No.
Sales Representative
Private Individual
Copy of ID
Cancelled cheque/bank statement / payslip
Signatures & Initials
Business
Order Number
Cancelled cheque
Signatures & Initials
Both
Debit order details details verified
Checked & Captured by:
Signatory ID
Subscriber name on all forms
Date:
VEHICLES: ADDENDUM TO THE STOLEN VEHICLE RECOVERY & GSM SERVICES CONTRACT
This document serves as an annexure to the "Agreement" as envisaged in item 1.2.1 of the Terms and Conditions of Agreement attached the VEHICLE
TRACKING & GSM SERVICES CONTRACT entered into between the Subscriber described below and WT24/7.