Unnumbered Page Advertisement 1

Forest and Bird, Issue 313, 1 August 2004, Unnumbered Page

Join, renew or make a regular donation by direct debit For direct debit please complete the forms and return to Forest and Bird Every year we process over 25,000 cheques. Processing For direct debit please complete the: Please post completed forms to: them is a time consuming and labour intensive job. You can 1 Direct Debit MembershiplDonation Form Forest and Bird, PO Box 631 Wellington help by paying your membership and donation by direct debit; 2 Direct Debit Bank Authority Form For assistance phone 04-385 7374 1. Direct Debit Membership/Donation Form 2. Direct Debit Bank Authority Form This is a New membership Bank Instructions Renewal (membership # if known NAME: Authority to Accept Direct Debits Membership to (of Bank_ Account) (Not to operate as an Name (Mr/Mrs/Ms) _ assignment or agreement) Address _ Bank account from which payments are to be made: Authorisation Code 0 6 0 3 5 3 Phone (wk) Phone (hm) Bank Branch Account number Suffix Email _ (Please attach an encoded deposit slip to ensure your number is loaded correctly) If this membership is a gift please complete the contact details above and To: The Bank Manager below: The gift membership will be sent with a card in the gift givers name: Bank: Gift membership from Name (Mr/Mrs/Ms) Branch: Address_ Town/City: IIe authorise you, until further notice, to debit mylour account with all amounts which Phone (wk) Phone (hm) ROYAL FOREST AND BIRD PROTECTION SOCIETY OF NEW ZEALAND INC . (hereinafter refered to as the Initiator) Email_ the registered Initiator of the above Authorisation Code, may initiate by Direct Debit IMe acknowledge and accept that the bank accepts this authority only upon the conditions listed below: Forest and Bird Membership (Prices include GST) Information to appear on mylour bank statement Single S52 Overseas (single) NZS95 Family S52 School S35 F 0 RI El S Tl & B R D Ti HIA IN IK ylol ul Senior single S39 Non-profit GroupILibrary S52 Payer Particulars Payer Code Payer Reference Senior family S39 Business S120 Student 835 Corporate S395 Your Signaturels Date Life (single only) S780 Donor member S250 Kiwi Conservation Club Membership (Prices include GST) For bank use only For you and your family For your school or group Approved Original Retain at Branch Bank Stamp Single S12 Mini Set 4 magazines) S28 1035 Date received: Recorded by: Checked by: Family (# of children_ S20 Class Set (30 magazines) S65 02 1999 Overseas (single) S28 2 Please debit my account Conditions of this Authority (b) In any event this Authority is subject to any arrangement now or hereafter 2 existing between melus and the Bank in relation to mylour account. Annually (January) The Initiator: (c) Any dispute as to the correctness or validity of an amount debited to myl Twice a year (January and July) our account shall not be the concern of the Bank except in SO far as the @ Monthly (may only be used where donation is included) (a) Has agreed to give written advance notice of the net amount of each direct debit has not been paid in accordance with this Authority: Any direct debit and the due date of debiting at least four business days other disputes lie between melus and the Initiator: before the date when the direct debit will be initiated_ The advance notice 2 Please complete the relevant boxes below will include the following message: 'The amount of S. will be direct (d) Where the Bank has used reasonable care and skill in acting in debited to your bank account on (initiating date)" . accordance with this authority; the Bank accepts no responsibility or 2 S Your annual membership (b) May, upon the relationship which gave rise to this Authority being liability in respect of: S Gift membership for terminated, give notice to the bank that no further Direct Debits are to be The accuracy of information about Direct Debits on bank statements_ initiated under the Authority: Upon receipt of such notice the Bank may Any variations between notices given by the Initiator and the amounts 2 Member number (if known) _ terminate this Authority as to future payments bynotice in writing to melus: of Direct Debits_ The Customer may: (e) The Bank is not responsible for; or under any liability in respect of the S Donation (annual amount) Initiator's failure to give written notice correctly nor for the non-receipt or 2 (a) At any time terminate this Authority as to future payments by giving late receipt of notice by melus for any reason whatsoever: In any such S Total annual amount (membership and donation) written notice of termination to the Bank and to the Initiator situation the dispute lies between melus and the Initiator: (b) Stop payment of any direct debit to be initiated under this authority by the Initiator by giving written notice to the Bank prior to the direct debit The Bank may: being paid by the Bank (a) In its absolute discretion conclusively determine the order of priority of If you are an existing_ member this authority will operate from the next date The Customer acknowledges that: payment byit of any monies pursuant to this or any other authority; cheque your membership becomes due for renewal: (a) This Authority will remain in full force and effect in respect of all direct or draft properly executed by melus and given to or drawn on the Bank If you join part way through the year_ a partial payment by direct debit may be debits made from mylour account in good faith notwithstanding mylour (b) At any time terminate this authority as to future payments by notice in required Should the membership fee be increased Forest and Bird are death, bankruptcy or other revocation of this Authority until actual notice writing to melus. authorised to automatically increase this amount of such event is received by the bank (c) Charge its current fees for this service in force from time-to-time_