{"id":2442,"date":"2023-06-09T10:38:46","date_gmt":"2023-06-09T10:38:46","guid":{"rendered":"https:\/\/servamusmagazine.co.za\/new\/?page_id=2442"},"modified":"2023-06-20T13:52:17","modified_gmt":"2023-06-20T13:52:17","slug":"debit-order-form","status":"publish","type":"page","link":"https:\/\/servamusmagazine.co.za\/new\/debit-order-form\/","title":{"rendered":"Debit Order Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2442\" class=\"elementor elementor-2442\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-eb156bb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"eb156bb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ce7d546\" data-id=\"ce7d546\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-04582e8 elementor-widget elementor-widget-heading\" data-id=\"04582e8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Debit Order Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c3b4c36 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c3b4c36\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bf3a845\" data-id=\"bf3a845\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bd14afa elementor-widget elementor-widget-shortcode\" data-id=\"bd14afa\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-2441 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-2441\" data-uid=\"69ef59bc33ca2\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2441\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2441 forminator-design--material  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"2441\"\n\t\t\t\t data-color-option=\"default\" data-design=\"material\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69ef59bc33ca2\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69ef59bc33ca2\" id=\"forminator-field-date-1-picker_69ef59bc33ca2-label\" class=\"forminator-label\">Date<\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_69ef59bc33ca2\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69ef59bc33ca2\" id=\"forminator-field-text-1_69ef59bc33ca2-label\" class=\"forminator-label\">Persal Number<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69ef59bc33ca2\" id=\"forminator-field-text-2_69ef59bc33ca2-label\" class=\"forminator-label\">ID Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69ef59bc33ca2\" id=\"forminator-field-text-3_69ef59bc33ca2-label\" class=\"forminator-label\">Rank<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69ef59bc33ca2\" id=\"forminator-field-text-4_69ef59bc33ca2-label\" class=\"forminator-label\">Initials <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69ef59bc33ca2\" id=\"forminator-field-text-5_69ef59bc33ca2-label\" class=\"forminator-label\">Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69ef59bc33ca2\" id=\"forminator-field-address-1-street_address_69ef59bc33ca2-label\" class=\"forminator-label\">Postal Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69ef59bc33ca2\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69ef59bc33ca2\" id=\"forminator-field-address-1-city_69ef59bc33ca2-label\" class=\"forminator-label\">City<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69ef59bc33ca2\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69ef59bc33ca2\" id=\"forminator-field-address-1-state_69ef59bc33ca2-label\" class=\"forminator-label\">Province<\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"\" id=\"forminator-field-address-1-state_69ef59bc33ca2\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69ef59bc33ca2\" id=\"forminator-field-address-1-zip_69ef59bc33ca2-label\" class=\"forminator-label\">Postal Code<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"\" id=\"forminator-field-address-1-zip_69ef59bc33ca2\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69ef59bc33ca2\" id=\"forminator-field-phone-1_69ef59bc33ca2-label\" class=\"forminator-label\">Tel (Work)<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69ef59bc33ca2\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69ef59bc33ca2\" id=\"forminator-field-phone-2_69ef59bc33ca2-label\" class=\"forminator-label\">Tel (Home)<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_69ef59bc33ca2\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_69ef59bc33ca2\" id=\"forminator-field-phone-3_69ef59bc33ca2-label\" class=\"forminator-label\">Cell Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-3_69ef59bc33ca2\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69ef59bc33ca2\" id=\"forminator-field-email-1_69ef59bc33ca2-label\" class=\"forminator-label\">Email Address<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69ef59bc33ca2\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p>&nbsp;<\/p>\n<p><strong>Banking Details<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69ef59bc33ca2\" id=\"forminator-field-text-6_69ef59bc33ca2-label\" class=\"forminator-label\">Bank <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69ef59bc33ca2\" id=\"forminator-field-text-7_69ef59bc33ca2-label\" class=\"forminator-label\">Account Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69ef59bc33ca2\" id=\"forminator-field-text-8_69ef59bc33ca2-label\" class=\"forminator-label\">Branch code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69ef59bc33ca2\" id=\"forminator-field-text-9_69ef59bc33ca2-label\" class=\"forminator-label\">Type of account <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-2441__field--select-1_69ef59bc33ca2\" id=\"forminator-form-2441__field--select-1_69ef59bc33ca2-label\" class=\"forminator-label\">Frequency<\/label><select  id=\"forminator-form-2441__field--select-1_69ef59bc33ca2\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Choose your option\" data-search=\"false\" data-search-placeholder=\"Choose your option\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2441__field--select-1_69ef59bc33ca2-label\"><option value=\"\"  >Choose your option<\/option><option value=\"Digital Monthly @ R38.00\"  data-calculation=\"0\">Digital Monthly @ R38.00<\/option><option value=\"Printed Monthly @ R54.00\"  data-calculation=\"0\">Printed Monthly @ R54.00<\/option><option value=\"Digital-3-Months-@-R114.00\"  data-calculation=\"0\">Digital 3 Months @ R114.00<\/option><option value=\"Printed-3-Months-@-R162.00\"  data-calculation=\"0\">Printed 3 Months @ R162.00<\/option><option value=\"Digital-6-Months-@-R228.00\"  data-calculation=\"0\">Digital 6 Months @ R228.00<\/option><option value=\"Printed-6-Months-@-R324.00\"  data-calculation=\"0\">Printed 6 Months @ R324.00<\/option><option value=\"Digital-Annually-@-R456.00\"  data-calculation=\"0\">Digital Annually @ R456.00<\/option><option value=\"Printed-Annually-@-R648.00\"  data-calculation=\"0\">Printed Annually @ R648.00<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69ef59bc33ca2\" id=\"forminator-field-text-10_69ef59bc33ca2-label\" class=\"forminator-label\">Date of deduction <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_69ef59bc33ca2\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Send Message<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"880f7e06f1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/new\/wp-json\/wp\/v2\/pages\/2442\" \/><input type=\"hidden\" name=\"form_id\" value=\"2441\"><input type=\"hidden\" name=\"page_id\" value=\"2442\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/servamusmagazine.co.za\/new\/debit-order-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Debit Order Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_editorskit_title_hidden":false,"_editorskit_reading_time":0,"_editorskit_is_block_options_detached":false,"_editorskit_block_options_position":"{}","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-2442","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/pages\/2442","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/comments?post=2442"}],"version-history":[{"count":10,"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/pages\/2442\/revisions"}],"predecessor-version":[{"id":3134,"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/pages\/2442\/revisions\/3134"}],"wp:attachment":[{"href":"https:\/\/servamusmagazine.co.za\/new\/wp-json\/wp\/v2\/media?parent=2442"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}