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    LG Puricare Auto Debit Form

    Uploaded by

    farizaziz77
    The customer provides their credit or debit card information and authorizes LG Electronics to automatically deduct monthly rental payments from the specified card. The customer agrees to the terms, which include LG Electronics not being responsible for failed payments and the customer being responsible for resolving any disputes with their card company. The authorization will remain in force until terminated in writing by the customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    LG Puricare Auto Debit Form

    Uploaded by

    farizaziz77
    180 views1 page
    The customer provides their credit or debit card information and authorizes LG Electronics to automatically deduct monthly rental payments from the specified card. The customer agrees to the terms, which include LG Electronics not being responsible for failed payments and the customer being responsible for resolving any disputes with their card company. The authorization will remain in force until terminated in writing by the customer.

    Original Description:

    Original Title

    LG PURICARE AUTO DEBIT FORM

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    © © All Rights Reserved

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    The customer provides their credit or debit card information and authorizes LG Electronics to automatically deduct monthly rental payments from the specified card. The customer agrees to the terms, which include LG Electronics not being responsible for failed payments and the customer being responsible for resolving any disputes with their card company. The authorization will remain in force until terminated in writing by the customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    180 views1 page

    LG Puricare Auto Debit Form

    Uploaded by

    farizaziz77
    The customer provides their credit or debit card information and authorizes LG Electronics to automatically deduct monthly rental payments from the specified card. The customer agrees to the terms, which include LG Electronics not being responsible for failed payments and the customer being responsible for resolving any disputes with their card company. The authorization will remain in force until terminated in writing by the customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Serial No.

    LG ELECTRONICS (M) SDN BHD


    Credit/ Debit Card Auto Debit Authorization
    Registration No. 200001003055 (505660-U) (AJL932279) T 03-7962 7777 F 03-7962 7700 W www.lg.com/my
    A-08-01, Level 8, Block A, PJ8, No.23, Jalan Barat, Seksyen 8, 46050 Petaling Jaya, Selangor Darul Ehsan, Malaysia.
    Customer Order Detail

    Customer Order No.:


    Monthly Payment of (RM) Rental Period: From Date To Date

    Name as per NRIC:


    NRIC/ Passport No.:

    Card Member's Name as per Card:


    Credit/ Debit Card Information Visa Master Issuing Bank:
    Card No. Expiry Date: /

    Card Holder’s Declaration


    1. Any personal information collected or held by the Company (whether contained in this application or otherwise obtained) is provided and may be held, used, and disclosed by
    the Company to individuals/organization related to and associated with the company or any selected third party (within or outside of Malaysia) for the purpose of processing this
    application and providing subsequent service for this and other products and services, cross marketing, direct marketing, and data matching, and to communicate with me/us for
    such purposes.
    2. I/we understand that I/we have a right to obtain access to and to request correction of any personal information held by the Company concerning me/us. Such request can be
    made to any of the Company's Customer Service Centre.
    3. I/We hereby declare that all information provided is to the best of my/our knowledge true and correct.
    4. I/We hereby acknowledge that a fee/charge will be charged to me/us in the event my/our account has insufficient balance to make payment instruction(s). I/We hereby agree for
    the Bank to debit related fees/charges from my/our account as a consequence of having insufficient fund for the auto debit purposes.
    5. I/We hereby authorise the Bank to debit my/our account for the auto debit payment(s) including the relevant transaction fees/charges not payable by the Company.
    6. I/We hereby agree to be bound by the Terms and Conditions specified in this form.
    7. This Credit/Debit Card Auto Debit Authorization will remain in force until terminated by me/us with prior written notice sent to the Bank/Company.
    Terms and Condition – Debit Authorization
    In consideration of LG Electronic (M) Sdn Bhd agreeing to accept my authorization for you to debit my Credit/Debit card account to pay LG Electronic (M) Sdn Bhd rental fee(s), I
    expressly agree to the following terms and conditions :
    1. I authorize LG Electronic (M) Sdn Bhd to debit my Credit/Debit card account for payment of rental fee(s) under the given rental agreement.
    2. The first debit shall commence any time from the date of submission of the authorization form. Subsequent debit will be made in accordance with the rental agreement
    frequency as advised by LG Electronic (M) Sdn Bhd.
    3. I shall accept full responsibility for all transactions arising from the use of this Credit/Debit card in payment of rental fee(s).
    4. LG Electronic (M) Sdn Bhd shall not be held responsible or liable for any claims, loss, damage, costs and expenses arising from the successful processing of the debit or the
    unsuccessful processing of the debit due to exceeding credit limit, malfunction of system, electricity failure and any other factors beyond the control of LG Electronic (M) Sdn Bhd.
    5. LG Electronic (M) Sdn Bhd is only responsible for making arrangement to debit my Credit/Debit card account through the card centre as authorized by me. Therefore, for any
    problem or dispute arising from the processing/debiting it will be my own responsibility to resolve it with my Credit/Debit card company.
    6. I will ensure that LG Electronic (M) Sdn Bhd is notified in writing of any changes, loss or replacement of my Credit/Debit card, or cancellation of this authorization at least one (1)
    month before the next rental fee(s) due. Such charges or cancellation will become only after LG Electronic (M) Sdn Bhd has duly acknowledged receipt of such request.
    7. LG Electronic (M) Sdn Bhd may at its absolute discretion at any time terminate this Credit/Debit card debit arrangement without assigning any reason by giving me one (1)
    month's notice in writing.
    8. LG Electronic (M) Sdn Bhd reserves the right to change the terms and conditions set out herein at any time or from time to time when circumstances warrant without prior notice
    to me.
    9. I hereby agree to indemnify and keep LG Electronic (M) Sdn Bhd indemnified against any claims, loss, damage cost and expenses which LG Electronic (M) Sdn Bhd may suffer
    or incur arising from my authorization to debit my Credit/Debit card account as aforesaid.
    10. Rental fees payment that are payable will be considered as paid only upon successful processing of the debit by the card centre.

    Card Holder's Card & Signature Verified By


    Name: Name:
    NRIC/ Passport: NRIC/ Passport:

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