Partnering Form - Living Life for Jesus

Name *

Email Address *

Phone

Date of Birth

Street Address

Suburb, Complex or Estate Name

City

State/Province

ZIP / Postal Code

Country

Bank Account Number *

Bank Name *

Branch Code *

Branch Location

Debit Order Instruction

I hereby authorize Living Life Ministries to draw against my account as detailed above or any other banking institute to which my account may be transferred, the sum as detailed below.

Due to the nature of this debit, I understand that the instruction will be cancelled should the debit not be honored for a period of two consecutive months. All such withdrawals from my account shall be treated as though they had been signed by me personally.

This authority may be cancelled by me, giving Living Life Ministries 30 day’s written notice, and I accept that I will not be entitled to any refunds of amounts withdrawn while this authority is in force.

Likewise changes to this instruction must be given in writing to Living Life Ministries – i.e.: amended amounts or banking details.

Receipt of this instruction by Living Life Ministries will be regarded as receipt thereof by my bank.

Type of Account *

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Swift Code

Today's Date *

Please fill in the Amount