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Main member

Single Member R149.99

Title*

Full name*

ID Number*

Date of Birth*

Cell Number*

Email*

Address*

Secondary member

Secondary members may be added at an additional R65 per member per month. All fees incurred by secondary members will be deducted from the account of the primary member.

Please note only direct family members of the primary member may qualify as secondary members.

Number of Secondary Members*

Total Amount Payable Per Month R149.99

*Please note that there is a once-off administration fee of R100.00 which will be added t o your first month’s payment.

Bank details

I hereby authorise Buddys Designated Drivers (Pty) Ltd to debit my account / credit card as follows:

Payment Type

Account Type*

Cheque

Savings

Transmission

Account Name*

Bank Name*

Branch*

Account Number*

Branch Code*

Reference

Terms & Conditions*

I hereby acknowledge that I have read and accepted the terms and conditions and all information I have disclosed herewith to be true and correct.

Security Question - What is 0 + 0*

Always have a BuDDy on standby!

Main member

Secondary member

Total Amount Payable Per Month R149.99

Bank details

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