Unnumbered Page Advertisement 1

Forest and Bird, Issue 310, 1 November 2003, Unnumbered Page

We invite new and existing BANK AUTHORITY FORM members to pay membership and donations by direct debit Direct Debit Every year we process in excess of 25,000 cheques As you BANK INSTRUCTIONS can imagine, this is a time consuming and labour intensive process. You can greatly assist the work that we do by making your NAME: AUTHORITY TO ACCEPT DIRECT DEBITS membership payments and donations by direct debit. (of Bank Account) (Not to operate as an assignment or agreement) AUTHORISATION CODE Pay your membershipldonations by direct debit Bank account from which payments are to be made: 0 | 6 | 1 | 0 3 5 3 If you are an exisiting member this authority will operate from the next date BANK BRANCH ACCOUNT NUMBER SUFFIX your membership becomes due for renewal (Please attach an encoded deposit slip to ensure your number is loaded correctly) Name (Mr/Mrs/Ms) To: The Bank Manager Address BANK: BRANCH: Phone (work) (home) TOWNICITY Email WE MAY NEED TO CONTACT YOU IF PROBLEMS ARE ENCOUNTERED SETTING THIS UP. Ie authorise you until further notice; to debit mylour account with all amounts which This is new membership renewal membership (member no.) ROYAL FOREST AND BIRD PROTECTION SOCIETY OF NEW ZEALAND INC (hereinafter referred to as the Initiator) GIFT MEMBERSHIP the registered Initiator of the above Authorisation Code; may initiate by Direct Debit: Join a friend by filling in their name above and your name below: Gift membership will be IWe acknowledge and accept that the bank accepts this authority only upon the conditions listed below: sent with a special gift card in your name Gift from (Mr/Mrs/Ms) Information to appear on mylour bank statement: Io R | E/s It & B / R D S |u |B /s /c|R/P |taoln T IHAA/NlK Iy /o| UI Address PAYER PARTICULARS: PAYER CODE: PAYER REFERENCE: Forest and Bird membership category (PRICES INCLUDE GST AND ARE ANNUAL EXCEPT LIFE) single family non-profit group $52 YOUR senior citizen senior family S39 SIGNATURE(S) DATE studentlschool S35 libraries $52 @ 8 overseas NZS95 For Bank Use only business (2 magazines) $120 1 5 Approved BANK STAMP corporate (4 magazines) 8395 # 1035 Original Retain at Branch life (single only) $780 g 2 02 1999 Date Received: Recorded by: Checked by: donor member S250 8 Kiwi Conservation Club membership category (PRICES INCLUDE GST) 3 2 single $12 family (no. of children $20 CONDITIONS OF THIS AUTHORITY overseas NZS28 The Initiator mini set 4 magazines) $28 (a) Has agreed to give written advance notice of the net amount of each (c) Any dispute as to the correctness or validity of an amount debited to school (10 magazines) 835 direct debit and the due date of debiting at least four business days mylour account shall not be the concern of the Bank except in So far school (15 magazines) S48 before the date when the direct debit will be initiated. The advance as the direct debit has not been paid in accordance with this Authority: class set (30 magazines) S65 notice will include the following message:- Any other disputes lie between melus and the Initiator The amount of $ will be direct debited to your bank account (d) Where the bank has used reasonable care and skill in acting in Please debit my bank account on a continuous basis as selected below: on (initiating date): accordance with this Authority, the Bank accepts no responsibility or 28th each month (may only be used where donation is included with subscription) (b) May; upon the relationship which gave rise to this Authority being liability in respect of:- 5 instalments, on the last day of January; February, March; April and May in any year terminated, give notice to the Bank that no further Direct Debits are to The accuracy of information about Direct Debits on bank statements_ 6 monthly on 28 January and 28 July be initiated under the Authority: Upon receipt of such notice the Bank Any variations between notices given by the Initiator and the annually on 15 January may terminate this Authority as to future payments by notice in writing amounts of Direct Debits to melus; (e) The Bank is not responsible for; or under any liability in respect of the IF YOU JOIN PART WAY THROUGH THE YEAR A PARTIAL PAYMENT BY DIRECT DEBIT MAYBE REQUIRED: Initiator's failure to give written notice correctly nor for the non-receipt SHOULD THE MEMBERSHIP FEE BE INCREASED FOREST AND BIRD ARE AUTHORISED TO AUTOMATICALLY The Customer may: or late receipt of notice by melus for any reason whatsoever: In any INCREASE THIS AMOUNT (a) At any time; terminate this Authority as to future payments by giving such situation the dispute lies between melus and the Initiator written notice of termination to the Bank and to the Initiator For the relevant portion of the following: (b) Stop payment of any direct debit to be initiated under this Authority by The Bank may: $ Current annual subscription the Initiator by giving written notice to the Bank prior to the direct debit (a) In its absolute discretion conclusively determine the order of priority S Gift subscription for: member number being paid by the Bank of payment by it of any monies pursuant to this or any other Authority; cheque or draft properly executed by melus and given to or drawn on member name The Customer acknowledges that:- the Bank (a) This Authority will remain in full force and effect in respect of all direct 2 $ Donation as outlined below (list annual amount here) debits made from mylour account in good faith notwithstanding mylour (b) At any time terminate this authority as to future payments by notice 8 $ Total annual amount death, bankruptcy or other revocation of this Authority until actual notice in writing to melus 2 of such event is received by the Bank (c) Charge its current fees for this service in force from time-to-time wish to make a regular donation to Forest and Bird of $ per annum (b) In any event this Authority is subject to any arrangement now or hereafter To be deducted from my bank account together with my subscription as outlined above or existing between melus and the Bank in relation to mylour account 1 To be deducted on the day closest to the 15 January every year: Complete the bank authority form attached and post together with the completed direct debit form above to: Forest and Bird, Freepost no 669, P 0 Box 631, Wellington