Paysoft Impact
Eyes2Eyes Donation Form
Thank you for your support, it is greatly appreciated. You are changing a life forever through the Gift of Sight.
Authorising person
I am signing on behalf of an organisation
I want a SARS Section 18A Tax Certificate
First names
Last name
Email address
Contact number
RSA ID Number
Tax reference
(Optional)
Additional info
Company name
Company reg no
(Optional)
Company contact no
(Optional)
Street names
Suburb
Town/City
Province/State
Postal code
Authorising company
Company name
Registration number
Contact number
Agreement
Account number
Account holder
Select a bank
Absa
Access Bank
African Bank
Bidvest Bank
Capitec
FNB - FIRSTRAND BANK
Nedbank
Standard Bank
FNB - FIRSTRAND BANK Lesotho
FNB - FIRSTRAND BANK Namibia
MTN Banking
Postbank (SAPO)
Standard Bank Lesotho
Standard Bank Namibia
UBank (was Teba Bank)
Discovery Bank
Investec Bank
Old Mutual Bank
Standard Chartered
Tymebank
SASFIN Bank Limited
Mercantile Bank
Bank Zero Mutual Bank
Capitec Business
Bank name
Select an account type
Current (Cheque)
Savings
Transmission
Account type
Start date
Indefinite
6 Installments
12 Installments
18 Installments
24 Installments
36 Installments
Custom
Contract Duration
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1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
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13th
14th
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17th
18th
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20th
21st
22nd
23rd
24th
25th
26th
27th
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29th
30th
31st
Debit day
No Increase
2.5%
5%
7.5%
10%
12.5%
Custom
Annual increase %
Custom annual increase (%)
Amount
100.00
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400.00
Own amount
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Legal agreement
Abbreviated short name as registered with the acquiring bank: EYES2EYES Refer to our contract reference number ("the contract reference number"). I/we hereby authorise The Eyes2Eyes Foundation. to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the contract reference number. The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of the agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the agreement. I/we agree that the first payment instruction will be issued and delivered on the "start date" and thereafter regularly on the "debit day" of each month. If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the agreement have been paid or until this authority is canceled by me/us by giving you notice in writing of not less than the interval (as indicated in the previous clause) and sent by prepaid registered post or delivered to your address indicated above. Mandate I/we acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally. Cancellation I/we agree that although this authority and mandate may be cancelled by me/us, such cancellation will not cancel the agreement. I/we also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you. Assignment I/we acknowledge that this authority may be ceded or assigned to a third party if the agreement is also ceded or assigned to that third party.