Common use of DEBIT ORDER Clause in Contracts

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

DEBIT ORDER. The Account Holder authorises Med-e-Mass MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to Med-e-Mass 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)................................................................................................. Signature ......................................................................................Date ..................../................../ 20.........................Full Name) .....................................................................................................

DEBIT ORDER. The Account Holder authorises Med-e-Mass MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to Med-e-Mass 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 nameFull Name)................................................................................................. Signature ......................................................................................Date ..................../................../ 20..............................................................................................................................

DEBIT ORDER. The Account Holder authorises Med-e-Mass MediSwitch to debit the Bank Account, details of which appear below, in payment of monies payable to Med-e-Mass 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…………………………………………………... TYPE BRANCH CODE: .............................. ................................... Signed by (full name)................................................................................................. ...................................................................................................... Signature ......................................................................................Date ..................../................../ 20.........................