Online Debit Order

Activate a debit order on your credit card to support us

Thank you for supporting us financially. Please complete the form below. After you have confirmed the amount you will be taken to the payment window. Your personal information is confidential and will not be given to any other institution.

Title:
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Surname: *
Name or Initials: *
Date of Birth (YYYY/MM/DD): *
Gender:
Postal Address: *
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Postal Code: *
Country:
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Telephone: *
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E-mail: *
Amount (in Rands): * (ZAR) Currency Converter
Please enter the marketer information if applicable
Name:
Code:
 
 
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