PURCHASE CARD PROTECTION FUND

Member Number:
Title: Initials: Surname:
Telephone No. (Home): E-mail:
Telephone No. (Work):
Cellular Phone No. :


Please debit my account with : R and thereafter yearly in December in respect of all purchase cards issued on my membership number, i.e R12.00 x ___(number of cards) and include my name on your list of members who are entitled to the benefits of the abovementioned fund.

 

I accept the conditions as set out in the conditions of the Card Protection Fund.

Date : Signature :

 

 

 

 

 

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