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Karamba Reseller Sign up Formx


Karamba Reseller Sign up Formx

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									Tel: +27 (0)21 415 3100 ▪ Fax: +27 (0)86 680 1396 Direct: +27 (0)21 415 3102 ▪ Cell: +27 (0)84 466 1258 Email: Address: 16 Napier Street, Cape Town, South Africa

Reseller Details Company Name / Individual: ID No: Address:

Company Reg: Company VAT: Postal Code: (Night): Cell: Realm: (R 300 monthly cost)

Phone: (Day) Fax:

Existing e-mail/other e-mail: Debit Order Details I-Soft Net is hereby authorized to arrange with my bank or building society to collect monthly subscription rate against my bank or transmission account (where ever it may be) in terms of a debit order. This authority will remain in full force until cancelled by me/us by 30 days written notice to I-Soft Net. Account Number: Account Name: Name of Bank: Branch: Branch Code: Reseller Confirmation
I understand that my monthly payments and any outstanding payments which fall outside of the normal monthly services will be debited from the above bank account

I confirm that I am willing to accept being billed Electronically Name (Printed) I have read and agree with the Terms and Conditions (Signature) Date:
STANDARD BANK - THIBAULT SQUARE Branch Code: 02-09-09-00 ACC No: 070 867 623

I-Soft Net:

We will notify you within one business day whether your application has been approved

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