Common use of DEBIT ORDER Clause in Contracts

DEBIT ORDER. The Account Holder authorises MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to MediSwitch for services rendered (a copy of a cancelled cheque must be enclosed herewith). BANK NAME: ……………………………………… ACCOUNT HOLDER: ……………………………………………………………….............. ACCOUNT NO: ACCOUNT TYPE: Cheque Transmission Savings BRANCH CODE: ................................... Signed by (Full Name) .....................................................................................................

DEBIT ORDER. The Account Holder authorises MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to MediSwitch for services rendered (a copy of a cancelled cheque must be enclosed herewith). BANK NAME: ……………………………………… ACCOUNT HOLDER: ……………………………………………………………….............. ACCOUNT NO: ACCOUNT TYPE: Cheque Transmission Savings BRANCH CODE: ................................... Signed by (Full Name) ).....................................................................................................

DEBIT ORDER. The Account Holder authorises MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to MediSwitch for services rendered (a copy of a cancelled cheque must be enclosed herewith). Cheque Transmission Savings (except FNB) BANK NAME: ……………………………………… ACCOUNT HOLDER: ……………………………………………………………….............. ACCOUNT NO: NO ACCOUNT TYPE: Cheque Transmission Savings TYPE BRANCH CODE: ................................... Signed by (Full Name) .....................................................................................................full name)...................................................................................................... Signature ......................................................................................Date ..................../................../ 20.........................

DEBIT ORDER. The Account Holder authorises MediSwitch Med-e-Mass to debit the Bank Account, details of which appear below, in payment of monies payable to MediSwitch Med-e-Mass for services rendered (a copy of a cancelled cheque must be enclosed herewith). BANK NAME: ……………………………………… ACCOUNT HOLDER: ……………………………………………………………….............. ........ ACCOUNT NO: ……………………………………..... ............ACCOUNT TYPE: Cheque Transmission Savings …………………………………………………... BRANCH CODE: ................................... .............................. Signed by (Full Name) .....................................................................................................full name)................................................................................................. Signature ......................................................................................Date ..................../................../ 20.........................