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Customer Information

INSTITUTION NAME:
CONTACT EMAIL:
CUSTOMER NO:

Monthly Debit Order

SABINET INVOICE NUMBER (AS PER INVOICE):
DEBIT ORDER AMOUNT (e.g. 123.12):

The invoice number and debit order amount must correspond with the invoice you receive. – THIS IS THE AMOUNT THAT PAYGATE WILL DEBIT FROM YOUR CREDIT CARD MONTHLY.

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