Order Form "*" indicates required fields Personal DetailsName* First Name Surname ID Number*Contact Number*Email* Address* Street Address Complex and Unit Number (If applicable) PackagesAir Fibre*10 mbps - R40015 mbps - R45030 mbps - R55050 mbps - R650100 mbps - R999Bank DetailsBanks*Select BankABSAFNBStandard BankNedbankCapitecInvestecAfrican BankTymeBankDiscovery BankBidvestAccount Number*Account Types*CurrentSavingsDebit Order Mandate Abbreviated name as registered with the bank: OXYGNISP I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned account at my/our above-mentioned Bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement and commencing on 10/10/2026 and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 (Twenty) ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above. I acknowledge that Oxygn ISP may debit my account each month on the abovementioned date. I further acknowledge that a returned debit may result in a further attempt being made on a different day and may further result in Oxygn ISP making use of a bank tracking facility to determine when such further debits should be processed. I further acknowledge that a failed payment may result in Oxygn ISP processing a double debit order the following month, to which I expressly agree. The individual payment instructions so authorised to be issued must be issued and delivered monthly. In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day. I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. Mandate I/We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the instructions have 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 shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, 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, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.Authorised Signatory Name*Date* DD slash MM slash YYYY Signature*Consent* Tick the box to indicate that you have read, and agree, to the terms and conditions*Consent Can we notify you via our communication channels, namely WhatsApp, Email or SMS?Consent Can we notify you of any upcoming promotions and news related to our security, financial, educational and lifestyle products?