Name:  ________________________________    DOB: _________________  Schedule:                                                                                                                                           

Training Packages:

Privates (one on one with instructor) Semi-Privates (max 4 clients per instructor) Classes  
o   R505 per session for month to month o   R405 per session month to month o   R2170 month to month
o   R440 per session for 3 months o   R345 per session for 3 months o   R1620 per month for 3 months
o   R390 per session for 6 months o   R300 per session for 6 months o   R1270 per month for 6 months
o   R345 per session for 12 months o   R220 per session for 12 months o   R1070 per month 12 months

If you’re not fitter, stronger  & happier after your first 30 days, tell us and we will stop your contract and give you your money back!  

Kids under 16 on a month to month basis.

  1. Authority

Given by (name of account holder)   ______________________________________________

Address                       ____________________________________________________

Contact              (C)_____________________(Email)_________________

Bank                              ____________________________________________

Branch and Code           ____________________________________________

Account Number          ____________________________________________

Type of Account (delete that which is not applicable)   Current (cheque) / Savings / Transmission

Amount                                            _______________

Debit Order Commencement Date       7th/10th/28th of _______(month)    _______(year)

including pro rata amount of ______ for ______ (month), when contract comes into effect.  

To Prometheus Uncaged T/A Fight Sports Centre                                         

59 Grant Ave Norwood

This signed Authority and Mandate refers to our contract dated____________________(“the Agreement”).

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 (unless so authorized in writing by both parties) and commencing on_________________ and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above. This Authority and Mandate cannot be cancelled until the agreement has run its full duration, which was specified earlier in this agreement.


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 Saturday, Sunday, or recognised South African public holiday, the payment day will automatically be previous business day. Payment instructions due in December may be debited against my account on ________________.

I/We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in Section E before the issuing of any payment instruction.

  1. 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. I/We agree to pay any penalty bank charges relating to this debit order instruction.

  1. 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, nor do I/we have the right to cancel this agreement before it has run for its full duration, which was specified earlier in the contract.

  1. 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.

Signed at ____________ on this ________ day of_________________ .


(Signature as used for operating on the account)


(Assisted By)

  1. Agreement Reference Number
This Agreement reference number for debtor is FIGHTSPORT
Abbreviated Name Your Debtor Account Reference
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