Unnumbered Page Advertisement 1

Forest and Bird, Issue 309, 1 August 2003, Unnumbered Page

We invite new and existing BANKAUTHORITY FORM members to pay membership and donations by direct debit Direct Debit BANK INSTRUCTIONS Every year we process in excess of 25,000 cheques As you AUTHORITY TO ACCEPT DIRECT DEBITS NAME: can imagine, this is a time consuming and labour intensive (of Bank Account) (Not to operate as an process: You can greatly assist the work that we do by making assignment or agreement) your membership payments and donations by direct debit AUTHORISATION CODE Bank account from which payments to be made: 6 1| 0 3 5 3 Pay your membershipldonations by direct debit BANK BRANCH ACCOUNT NUMBER SUFFIX (Please attach an encoded deposit slip to ensure your number is loaded correctly) If you are an exisiting member this authority will operate from the next date your membership becomes due for renewal To: The Bank Manager Name (Mr/Mrs/Ms) BANK: Address BRANCH: TOWNICITY Phone (work) (home) INe authorise you until further notice, to debit mylour account with all amounts which Email ROYAL FOREST AND BIRD PROTECTION SOCIETY OF NEW ZEALAND INC We may need to contact you if problems are encountered setting this up. (hereinafter referred to as the Initiator) the registered Initiator of the above Authorisation Code may initiate by Direct Debit This is a new membership INe acknowledge and accept that the bank accepts this authority only upon the conditions listed below: renewal membership (membership no,) Information to appear on mylour bank statement: GIFT MEMBERSHIP above and below: Gift membership F 0 R Els T & B /1IR D S Ju B /S Ic IR/up It |uol N T IHIAIN Kl Y lo|ul Join a friend by filling in their name your name will be sent with a special gift card in your name_ PAYER PARTICULARS: PAYER CODE: PAYER REFERENCE: Gift from (Mr/MrsMs) Address YOUR SIGNATURE(S) DATE Forest and Bird membership category (prices include GST and are annual except Life) single family non-profit group 552 3 8 senior citizen D senior family $39 Approved For Bank Use only studentlschools 935 libraries 552 1 8 1035 Original Retain at Branch BANK STAMP business 5120 life (single only) $780 Date Received: Recorded by: Checked by: overseas NZS95 corporate $275 g 02 1999 donor member 5250 2 2 8 Kiwi Conservation Club membership category (prices include GST) 8 single 512 family (no. of children S20 2 CONDITIONS OF THIS AUTHORITY mini set (4 magazines) 522 class set (30 magazines) S55 The Initiator overseas NZS22 Has to written advance notice of the net amount of Any dispute as to the correctness or 'validity of an amount debited (a) Hiachaaireed C tebivd the due date of debiting at least four business to mylour account shall not be the concern of the Bank except Please debit my bank account on a continuous basis before the date when the direct debit will be initiated The in SO far as the direct debit has not been paid in accordance with as selected below: ddvahei notice will include the following message: this authority: Any other disputes lie between melus and the 28th each month (may only be used where donation is included with subscription) The amount of $. will be direct debited to your bank account Initiator: 5 instalments; on the last day of January February March;_ April and May on (initiating date): d) Where the bank has used reasonable care and skill in acting in in any year: the relationship which gave rise to this Authority being accordance with this authority; the Bank accepts no responsibility 6 monthly on 28 January and 28 July (b) terrinaoed notice to the Bank that no further Direct Debits or liability in respect of: annually on 15 January to be chitiaced under the Authority: Upon receipt of such the accuracy of information about Direct Debits on bank are notice the Bank may terminate this Authority as to future payments statements; If you join part way through the year a partial payment by direct debit maybe required: Any variations between notices given by the Initiator and the by notice in writing to melus: Should the membership fee be increased Forest and Bird are authorised to automatically amounts of Direct Debits increase this amount The Customer may (e) The Bank is not responsible for; or under any liability in respect (a) At any time. terminate this Authority as to future payments by of the Initiators failure to give written notice correctly nor for For the relevant portion of the following; giving written notice of termination to the Bank and to the Initiator the non-receipt or late receipt of notice by melus for any reason $ Current annual subscription (b) Stop payment of any direct debit to be initiated under this authority whatsoever In any such situation the dispute lies between melus Gift subscription for: member number by the Initiator by giving written notice to the Bank prior to the and the Initiator; member name direct debit being paid by the Bank The Bank may $ Donation as outlined below (list annual amount here) The Customer acknowledges that: In its absolute discretion conclusively determine the order of $ Total annual amount a) This authority will remain in full force and effect in respect of all priority of payment by it of any monies pursuant to this or any direct debits made from mylour account in good faith other authority cheque or draft properly executed by melus and 2 wish to make a regular donation to Forest and Bird of per annum; notwithstanding mylour death; bankruptcy or other revocation of given to or drawn on the Bank 8 this authority until actual notice of such event is received by the 8 D To be deducted from my bank account together with my subscription as outlined At any time terminate this authority as to future payments by Bank above or: notice in writing to melus; 3 To be deducted on the day closest to the 15 January every year (b) In any event this authority is subject to any arrangement now or for this service in force from time-to- hereafter existing between melus and the Bank in relation to Charge its current fees 8 Please make my annual donation: $ account time_ mylour 8 Complete the bank authority form overleaf and post together with your completed direct debit form to: Forest and Bird; Freepost no 669, P 0 Box 631, Wellington