Application Form - RAMAHLO MS & ASSOCIATES ATTORNEYS

SECTION A: Personal / Business Details

Full Name / Business Name *

ID Number / Registration Number *

Contact Number *

Email Address *

Physical Address *

R145 – Basic Retainer 1 consultation/month, document review, basic guidance

R195 – Standard Retainer 1 consultation/month (45 min), 2 document reviews, drafting

R265 – Premium Retainer 2 consultations/month, 3 document reviews, priority support

Account Holder Name *

Bank Name *

Account Number *

Branch Code *

Account Type *

Preferred Debit Date (1–28) *

I consent to a debit check being conducted *

I authorise monthly debit order deductions *

I accept the Retainer Agreement and Terms & Conditions *

Note: A debit check will be conducted to verify your banking details. No funds will be deducted during this check. Learn more about debit checks.

Full Name (Electronic Signature) *

Date *

By submitting this form, you confirm that all information provided is accurate and complete.