PAYMENT AUTHORIZATION FORM
The undersigned authorizes CellSave Arabia to charge his/her credit/debit card for the amounts to be invoiced for the services as specified in the Service Agreement in Section A and Fee Schedule in Section C.
SERVICE PROVIDED BY: CELLSAVE ARABIA FZ LLC
MONTHLY INSTALLMENT AMOUNT:
CARDHOLDER'S FULL NAME:
FIRST INSTALLMENT DATE:
LAST INSTALLMENT DATE:
CARD TYPE: VISA MASTER CARD
PAYMENT TERMS:1 month2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 months
I hereby confirm that I am the authorized holder of this card and have no objection for the beneficiary banker to check with me/my bank, which has issued the card. Instructions given by you shall be treated by my bank as instructions as if given by me personally. The number of the payment instructions may never exceed my indebtedness or obligations in terms of the agreements. The first payment instruction is to be delivered for payment to my bank on a date which is 3 days from the date hereof. Payment instructions must be given to my bank to correspond with the date so identified and selected, or as close as possible to such date, until such time as my obligations have been settled in full. I specifically agree that you may present two payment instructions in a payment cycle in the event that a past due payment was not honored. I agree that should my Primary Credit Card given failed for whichever reason, the secondary Debit Card can be used. I foresee that I may change my bank and bank account particulars reflect herein in which instance I am obligated to notify you of such change and provide you with my new bank particulars. Should I however not notify you, or you obtain my new bank particulars on your own account, this authority will not lapse and continue to cover such new bank information obtained. Such new bank particulars shall be read in conjunction with this signed authority by my new bank. I agree and understand that although this authority may be canceled; such cancellation will not cancel the agreement I have with you. I understand that I cannot reclaim payments made by my bank whilst such amounts still legally owed and due to you. This authority may be ceded or assigned to a third party, provided that the underlying agreement is also ceded or assigned.
IF ANY ALTERATION OR MANIPULATION OF THE ABOVE DATA IS MADE THIS FORM WILL NOT BE VALID
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Document Name: PAYMENT AUTHORIZATION FORM
Agree & Sign