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I confirm that I am duly authorised to make this application on behalf of the Applicant and that the Applicant has the necessary legal capacity to enter into an agreement with Shoprite Checkers Pty Ltd as envisaged. Type your full name as a signature Date Please email this form to the Shoprite Group Card Division businesscard shoprite. Debit Order Authorisation Would you like to pay your Shoprite Group Edu Card by debit order Yes No If yes please complete the details below Bank Account Number...
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