Please complete the following in full.

On submission, a copy of this mandate will be emailed to you for your records.


Your Details


Business Address


Debit Order Information

Eg. Hosting Services, Website Maintenance, SEO Services
Debit amount will be as per invoice/agreement

Bank Details

Eg. Cheque, Transmission, Savings

Abbreviated name as registered with the Bank: VERTOPIA.

I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned account at my/our above-mentioned Bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to, which commences on:

Select last day of the month
DD slash MM slash YYYY

and continues until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days and receipt must be confirmed by Vertopia cc.

The individual payment instructions so authorised to be issued must be issued on the last day of the month or there about and delivered either Monthly, Quarterly, Semi-Annually or Annually based on service renewal cycles and in accordance to invoice.

Payment Instructions due in December may be debited against my account by the 15th of December.

In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day.

All failed debit orders, due to insufficient funds, will incur a penalty fee of R300 per failed debit order. After 2 failed debit orders you will automatically be switched to manual payment option.

I / We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

I / We acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally.

I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. 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.

Included with this mandate:
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Time Stamp: 29 February 2024