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Home
About Us
Our Products
Mobile System
Indoor System
Retirement Village Solutions
Contact Us
Book A Demonstration
Home
About Us
Our Products
Mobile System
Indoor System
Retirement Village Solutions
Contact Us
Book A Demonstration
Debit Order
Submission
Agreement Number
Device ID
First Name
Last Name
Email Address
Date
Bank
Bank*
FNB - 250655
Capitec - 470010
ABSA - 632005
Standard Bank - 051001
Nedbank - 198765
Investec - 580105
Discovery - 679000
Tyme - 078910
Bidvest - 462005
Account Type
Account Type*
Cheque/Current
Savings
Account Holder Name
Account Number
Debit Order Amount
Debit Order Amount*
R149 (If and when you sell the additional “I’m Okay Service”)
R199 (Add Service Special Rate)
R219 (The updated subscription fee for additional/second devices)
R274 (Village Fee)
R299 (Current IP promotional subscription)
R329 (Normal IP subscription fee)
R349 (Current GSM device/s subscription fee)
R379 (For future purposes)
R498 (R299+R199) (IP Combo Special)
R518 (R299+R219) - New IP Combo Special
R528 (R329+R199) (Normal IP Combo Pricing)
R548 (R349+R199) (Current GSM Combo Special)
R548 (R329+R219) - New IP Combo Normal
R568 (R349+R219) - New GSM Combo Special
R578 (R379+R199) (Normal GSM)
R598 (R379+R219) - New GSM Combo Normal
Debit Order Date*
Debit Order Date*
1st
5th
7th
10th
15th
Signed At
On This Day
Consent
I have read and agree to the
Terms and Conditions
Consent
I hereby permit AidCall 24/7 to debit my above stated account
Additional Comments
Comments
Submit
