DEBIT ORDER
Please print this form and fax it to: The Bible Society of Mauritius or post it to:

The Executive Director
Bible Society of Mauritius
Cnr. S. Fouquereaux & de Gaulle Streets
Eau Coulée
Mauritius

Amount RS: .

Amount in words:

I understand that the amount will be debited against my account,
as indicated below, on the first business day of each month and
that I will give one month's written notice if I wish to cancel it.

Please debit my:

Savings Account

Current Account

Name of Account Holder:

Postal Address:

Telephone:

Bank:

Branch:

Account Number:

Signature of Account Holder:

Date: