HiTMail ShoutOut Order Form

HiTMail ShoutOut Order Form. Order your bulk email campaign here. Our services include designer email templates, email campaigns, and database management.

Select Services Required - Step 1 of 5

HiTMAIL SHOUTOUT ORDER FORM

For Bulk Emailing Newsletters, Specials, Notices, Adverts, etc

Individual Customer
Business Customer

APPLICANT INFORMATION

Name *

First

Last

Email *

Cell Phone *

Landline Number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

BANK AUTHORISATION

1 - Download the Debit Order Mandate/Instruction.
2 - Upload the completed form for processing.

<<< Click Here to Download the Debit Order Mandate/Instruction>>>

Upload Debit Order Mandate/Instruction *

Click or drag a file to this area to upload.

Upload the signed debit order instruction (pdf format)

Bank Account Verification Upload *

Click or drag a file to this area to upload.

Only Bank Verification letter in pdf format will be accepted.

Debit Order Mandate Agreement *

I Agree

I hereby request and authorise Haimsa iT to draw against my account with the above mentioned bank (or any other bank or branch to which I may transfer my account) the collective sum stated from the services I selected above annual and/or once-off; or any variable amount pertaining to this agreement. This being the amount necessary for the payment of the annual/once-off premium due to Haimsa iT in respect of our purchases/ contract/ agreement selected above. All such withdrawals from my bank account by Haimsa iT shall be treated as though they had been signed by me personally. I understand that the withdrawals authorised here will be processed by First National Bank and I also understand that the details of each withdrawal will be printed on my bank statement. I agree to pay any bank charges relating to this debit order instruction. Furthermore I agree that should the bank dishonour any payment to Haimsa iT, Haimsa iT shall be entitled, over and above the dishonoured payment as well as bank charges, be obliged to pay an additional administration fee of Fifty Rands (R50.00) per failed transaction. This authority may be cancelled by means of giving Haimsa iT thirty days’ notice in writing, but I understand and acknowledge that I shall not be entitled to any refund of amounts, which have already been withdrawn whilst this authority is in force if such amounts were legally owing to Haimsa iT. I acknowledge that I may not delegate any of my obligations in terms of this contract/authority to any third party without prior written consent of the Haimsa iT. I warrant that I am an authorised representative and legal entity of the Customer and duly authorised hereto to sign and accept this agreement. I acknowledge to have read, understood and agree to be bound by the standard terms and conditions of this contract agreement and that of Haimsa iTs other agreements; a copy of which is available online at www.haimsait.co.za. Furthermore I declare that the information provided herein is true and correct.

HiTMail ShoutOut Order Form