Web Design for all | Hosting In SA

Debit Order Request

debit order image

Debit Order Authorisation & Mandate for Monthly Web Hosting & Digital Marketing Services


I agree for my personal data to be processed and for the use of cookies in order to engage in a transaction processed by Hosting In SA, for the purpose of a monthly debit order.

By clicking below to submit this form, you acknowledge that the information you provide for processing is in accordance with our Terms & Conditions.
Please note that we will not be able to maintain your monthly Web Hosting if the debit mandate is not completed and signed. Under no circumstances will we accept cash or cheques. If you are paying by EFT, note that all Proof of Payment must be emailed to John Mason at billing@hostinginsa.com. All payments must be processed through the legal channels/payment gateways provided.

Authorised Person:

Registered Company Name:  

Company Registration Number:  

Authorised person Identity Number:  

Contact Number:  

Alt. Contact Number:  

Email Address:  

Banking Institution:

Account Number:  

Type of Account:  Account Type


Frequency Debit Order Date: of the month.

Product & Subscription Amount:  Web Design & Digital Marketing Services


Agent/ Consultant Name:  



Registration Number: 2016/501694/07

with bank abbreviated name RESAHOSTIN

This signed Authority and Mandate refers to our contract Dated: / / , ‘The Agreement’, I hereby authorise you to issue and deliver payment instructions to your banker for collection against my above mentioned account at my above mentioned bank (or any other bank or branch to which I may transfer my account) on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the Agreement, and commencing on / / , and continuing until this Authority and Mandate is terminated by me by giving you notice in writing of not less 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.

The individual payment instructions so authorized to be issued must be issued and delivered as follows:  The amount will be debited with a valid reference on your bank statement.

In the event that the payment day falls on a Sunday or recognized South African public holiday, the payment day will automatically be the preceding ordinary business day. Furthermore, if there are insufficient funds in my 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.

Payment Instructions due in December may be debited against my account on / /

I understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my bank statement. Such must contain a number, which number must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in Section E before the issuing of any payment instruction.


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


I agree that although this Authority and Mandate may be cancelled by me, such cancellation will not cancel the Agreement. I 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.


I acknowledge that this authority may be ceded 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.

Signed ONLINE on this / / .

!!! Note That All Orders Are Subject To a Successful Debit process. Your Details will be Deleted and/or Blocked from our system after 14 days, in the event of an unsuccessful Debit!!!

For Any Queries Please Not Hesitate To Contact Our support line on +27(0) 31 401 1359 | +27(0) 32 541 0212 | +27(0) 87 654 8677 or email our support department on customercare@hostinginsa.com | support@hostinginsa.com

I have read and agree to all Terms and Conditions for Online Purchases View Terms and Conditions

I   to the Terms and Conditions of this Online Order.

I the use of Electronic Signature


Website Security Services Acceptance / Decline

We take website security very seriously as it is one of the best things you can do for your online business. Protecting a website will save you a tremendous number of hours (or even weeks) in the event of an attack.

Unfortunately, website attacks are very common and websites of all sizes are targets.

Did you know?

  • Tens of thousands of websites are hacked everyday
  • Google blacklists nearly 10,000 websites every single day
  • A website can be hacked and redirect visitors to another website without the website owner even knowing anything is wrong?
  • A site’s organic rankings and traffic can disappear if a site is hacked or has malware
  • Most hosting companies don’t take proper or frequent backups of hosted websites and are often even the source of the problem

What can our website security services do for you?

Our job is to do our best to secure your website and deter hackers. We can implement specific security measures to protect your website and continuously monitor it to help deter attacks and take immediate action in the event of an attack. This could make the difference of your website being down for a few minutes versus days or even weeks.

Not sure if you need website security services?

If you don’t believe website security is required for your website, ask yourself the following questions:

  • What would you do if your website went offline for a week or longer?
  • How much would it cost you to rebuild your website?
  • How much revenue would you lose if your site went down?
  • How much revenue would you lose if you lost your organic rankings because your site was blacklisted?

  Choose One



The AGREEMENT Reference Number: WHD




Leave this empty:

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Signed by John.M Mason
Signed On: 22/05/2020

Web Design for all | Hosting In SA https://hostinginsa.com
Signature Certificate
Document name: Debit Order Request
lock iconUnique Document ID: 4d4b68ef1946a42130a129ce890455e7ea5392f4
Timestamp Audit
04/04/2018 2:50 pm SASTDebit Order Request Uploaded by John.M Mason - customercare@hostinginsa.com IP

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