Sales Agreement

"*" indicates required fields

Step 1 of 2

ACCOUNT HOLDER (DEBTOR) INFORMATION:

Name*
Address*
Account Type:*

Collection Instructions

Interval*
Authority is hereby granted to XIT or its appointed agent to debit my/our account with any and all amounts due in terms of this subscription and/or debit order agreemnt
Service Fee*
Note: If variable, the amount(s) hereunder may be exceeded.
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Recurring transactions: Continue Indefinitely Untill Cancelled by debtor?
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the above mentioned and undersigned, hereby authorize XCHNGE to collect by debit order from the above mentioned bank account, all amounts due in terms hereof to be debited as the above.
is the person with signature authority as registered with my bank to authorized electronically.
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The abbreviated name that will appear on bank statement will appear as Xchnge
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