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PLEDGE R50 PER MONTH AND WIN A MOTORMIA 125cc SCOOTER WORTH R8 000
Dear DARG suPAWter
DARG is entirely reliant on the public for funding and we thank you for your ongoing support. We invite you
to be one of the 500* pledges required for us to reach the 2000 pledge milestone. In doing so you stand to
win a fantastic Motormia Scooter!
TERMS AND CONDITIONS
1. You can pledge by Debit Order or a once-off payment.
2. A minimum of R50 for 12-months applies (or R600 in total for the year).
3. The number of entries into the prize draw will be based on R50 increments as follows: 1 entry = a pledge
of R50 per month for 1 year (or R600); 2 entries = a pledge of R100 per month for 1 year (or R1200) etc.
4. Existing DARG Debit Order members can also qualify for the prize draw subject to increasing your monthly
contribution by R50 or more and completing a new Debit Order form.
5. All entries received within one week (7 days) after the target of 500 x R50 pledges has been reached will
also qualify for the prize draw*.
6. The prize winner will be chosen at random from all the Pledge Entries received. The prize will be awarded
to the first name drawn and the winner will be notified telephonically or via email.
7. The decision of the organisers is final and no correspondence will be entered into.
8. Prizes cannot be amended, transferred or exchanged for cash.
9. The Prize Winner will be responsible for the collection of the scooter from DARG premises – Main Road
Hout Bay
10. DEBIT ORDERS: The Debit Order application form is contained on PAGE 2 of this document. Only correctly
completed Debit Order forms will be entered into the Prize Draw.
11. ONCE OFF PAYMENT: Should you not want to do a Debit Order you can make a once-off payment into the
following account (R600 – 1 entry / R1200 – 2 entries / R1800 – 3 entries etc.):
DARG - FNB: 62471702897 • Branch code: 201409 • REFERENCE: SCOOTER / your email or Tel
Please submit your Debit Order form / Proof Of Payment together with the signed Terms and Conditions to:
EMAIL: [email protected]
OR
FAX: 021 426 2049
I have read and understand the Terms and Conditions as stipulated herein.
NAME: ________________________________________
SIGNATURE: ____________________________________
DATE: __________________________________
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MAIN RD HOUT BAY
021 790 0383
www.darg.org.za
DEBIT ORDER / CREDIT CARD AUTHORISATION FORM
Name: _______________________________________ Surname: _________________________________________
ID No: _________________________________________________________________________________________
Address:________________________________________________________________________________________
_______________________________________________________________________________________________
E-mail: ___________________________________________ Tel: (H)________________________________________
Tel: (W) __________________________________________ Tel: (C) ________________________________________
Bank/Building Society: ______________________________ Branch Name:__________________________________
BRANCH CODE:
ACCOUNT TYPE:
CHEQUE
SAVINGS
CREDIT
VISA
MASTERCARD
ACCOUNT NUMBER:
CREDIT CARD TYPE:
(A) MONTHLY DONATION: R50
R100
R150
R200
R
EXPIRY DATE
(B) ONCE OFF: R
DATE: 15th
H
(C) I am an existing Debit Order DARG sponsor
My current monthly Debit Order value is
Please increase my debit order by this amount per month
R
29th
H
R
New monthly Debit Order value
R
I/We hereby authorize and instruct DARG to draw against the above mentioned account with the above mentioned
bank the sum of R _______________ on the 15th
day (“payment day”) of each consecutive month
29th
H
H
[as per (A) or (C) above] commencing on: _________________________________
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 very next ordinary business day. Further, 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 authorized will be
processed through a computerized system provided by the South African Banks and I also understand that the details of
each of each withdrawal will be printed on my/our bank statement. I/We agree to pay any bank charges relating to this
debit order instruction. I/We agree to pay any charges relating to unpaid/returned items with regards to this debit
order. This authority may be cancelled by me/us by giving DARG 20 business days’ notice, from the debit order date, in
writing. I/we understand that I/we shall not be entitled to any refund of amounts that DARG has withdrawn while this
authority was in force if such amounts were legally owing to DARG. Receipt of this instruction by DARG shall be
regarded as receipt thereof by my/our bank whichever it is or will be.
Signature: _____________________________ Date: _____________________________