Court Order Lay-by Agreement - Durban

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Full Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Items

Item {binding ItemNumber}

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Payment Schedule

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Payments

Payment {binding ItemNumber}

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I understand and accept the terms of this agreement.

{ binding firstError.message }

EFT Payment details:

Bank: FNB

Account type: Cheque

Branch code: 250 655

Court Order Lay-by Agreement - Durban

Court Order Lay-by Agreement - Durban

Start Date (First Payment) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Second Payment Due Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Final Settlement Due Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Full Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Items

Item {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Total Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Payment Schedule

First Payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{binding SecondPaymentDueFormSecondPaymentDueDate_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{binding FinalPaymentDueFormFinalSettlementDueDate_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Payments

Payment {binding ItemNumber}

Payment Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Payment Method {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Total Payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Balance Payable {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

I understand and accept the terms of this agreement.

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

EFT Payment details:

Bank: FNB

Account type: Cheque

Branch code: 250 655