Debit Order Form

Complete the form below or download a form here


By completing and submitting the form above, I hereby agree to the below terms and that the details provided are correct.  You have my authorisation to transact against the above mentioned bank account.

Terms and conditions

I hereby instruct and authorise DEBITSURE, acting on behalf of Monkey Helpline to draw against my account with the below mentioned bank, the amount specified below for the monthly donation due.

All such withdrawals from my bank account by you shall be treated as though they had been signed by me personally.

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

This authority may be cancelled by me by giving thirty days’ notice in writing, which can be sent by registered post, or by email. I understand that I shall not be entitled to any refund of amounts which have been withdrawn while this authority was in force.

The requirements for an authorization are that it needs to be in writing and in terms of the Electronic Communications and Transactions Act, the above form is constituted as an electronic data message, and therefore as legally binding as completing our standard printable form.

If you are uncertain about anything, please contact us, or you can manually complete the debit order form by downloading it here and email the completed form to or fax to 086 551 7688.

You can print the form and send it to  Download the form here:  Debit Order Form

​​Call us:

082 659 4711

082 411 5444

​Find us: 

10 Palmiet Drive

Westville, Durban

KwaZulu Natal


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