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Applicant Information

Service Options

Package

Installation (required)

Banking Details

Debit Order Declaration

This signed authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our above mentioned account at my / our above mentioned bank or any other bank or branch to which I or we may transfer my account on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the Agreement and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me by giving you notice in writing of no less than 20 ordinary working days and sent by prepaid registered post or delivered to your address indicated above.

Authorised Signatory

I accept and understand that this Service application is subject to Gironet‘s standard terms and conditions. This information can be viewed by visiting the following address, https://www.gironet.co.za/termsandconditions.pdf. I understand that the service will be deemed active once the service has been installed and activated. I understand the service is subject to availability and feasibility. I understand that fees for the service is billed and due in advance. I understand that the equipment installed by Gironet in a Standard Installation, remains the property of Gironet unless otherwise specified.