Membership Application Form

BUSINESS DETAILS

Business Type (Please check only one)

Business Description (required) Please enter a brief description of your main business activity

Physical Address (required)

Postal Address (required)

CONTACT DETAILS: PRINCIPAL MEMBER

First Name (required)

Last Name (required)

Position (required)

Duration (years) (required)

Cell Number* Please use international format, e.g. +27 11 555 1234

Date of Birth (required)

Email Address (required)

CONTACT DETAILS: ADDITIONAL MEMBER 1

First Name

Last Name

Position

Duration years

Cell Number Please use international format, e.g. +27 11 555 1234

Date of Birth

Email Address

CONTACT DETAILS: ADDITIONAL MEMBER 2

First Name

Last Name

Position

Duration (years)

Cell Number Please use international format, e.g. +27 11 555 1234

Date of Birth

Email Address

Which chamber would you like to join?

RandburgFourwaysLanseria

PAYMENT DETAILS

Annual Payment

1 - 5 Employees (R2 508 annually)6 - 10 Employees (R3 192 annually)11 - 20 Employees (R3 990 annually)21 - 50 Employees (R5 130 annually)51 - 100 Employees (R8 265 annually)100 or more Employees (R14 040 annually)Corporate Fee & Sponsorship (R57 000 annually)

Please send proof of payment to [email protected]

Monthly Payment

1 - 5 Employees (R228 per month)6 - 10 Employees (R285 per month)11 - 20 Employees (R365 per month)21 - 50 Employees (R456 per month)51 - 100 Employees (R741 per month)100 or more Employees (R1 170 per month)Sponsor Membership (R5 700 per month)

FORM OF AUTHORITY AND MANDATE IN RESPECT OF ALL ELECTRONIC DEBITS

Given By (Name of Account Holder) (required)

Address (required)

I/we hereby authorise The Randburg Chamber of Commerce and Industry NPO 031269 (RCCI) collection agency ACB Link (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in this membership agreement.

Date of first debit order shall be processed on the abovementioned day (payment day), thereafter date of subsequent debit orders shall be processed on the abovementioned day of every month, commencing in abovementioned year and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 30 calendar days, and sent by email.

In the event that the payment day falls on a Sunday or recognised South African public holiday, the payment day will automatically be the next ordinary business day.

I/we understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I/we also understand that details of each withdrawal will be printed on my bank statement, with the reference ‘RCCI’ and my unique client number.

I understand that my bank will apply charges at their ruling rates for unmet transactions.

I also understand that any banking fees incurred by my supplier may be recovered in the event of unmet transactions.

I/We 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.

I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the service agreement.

I/We 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.

 
 
Terms and Conditions

I accept the Terms and Conditions

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Signed: __________________________________