Crazyweb Fibre Application Form.

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Client Details

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Banking Details

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Contract Terms


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 / We may transfer my / our account) and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 30 calendar days, and sent by letter or e-mail or delivered to your address indicated above.
The individual payment instruction so authorised to be issued must be issues and delivered as follow:

i. On the last working day of each and every month commencing on the abovementioned commencement date.

ii. In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the previous working day.

iii. If there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account.

I / We understand that the withdrawals hereby authorised will be processed through a computerized 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I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.

MANDATE

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

CANCELLATION

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 I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.

ASSIGNMENT

I / We acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

Please attach the following proof

Accepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.
Please attach a picture or screenshot of your South African ID document
Accepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.
Please add a bank confirmation letter, this can be found in the documents section of your banking app or from an ATM / 3 months bank statements will also suffice.
Accepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.
Please attach a screenshot or image of your credit score to help speed up your application process, if proof of credit score is attached we will need to request this from Transunion which may delay the approval process.
By signing you confirm, that you have read and understand the above contract, and terms and conditions
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