Your Name (required)
Your Surname (required)
Your Email (required)
Your Telephone number (required)
ID Number / Date of birth
Emergency Contact name and number
Medical Aid name and number
I would like to pick up my card at the following outlet
---CycledelicCycletecCymotIJGMannie's Bike MeccaKleine Kuppe GateWaldorf Gate
Family weekender - N$170 monthly per family
Your photo (required) Maximum 2 Megabytes (2MB)
For family package please list additional family members (under 18) and/or spouse
Family member 2
Date of birth
Family member 3
Family member 4
Family member 5
Monthly installment (Auto renewal)
First debit order date
Bank Account Name
Type of account
I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.
The individual payment instructions so authorised to be issued must be issued and delivered as follows: On the day selected above (''payment day'') of each and every month commencing in the commencement date selected above. In the event that the payment day falls on a Saturday, Sunday or recognised Namibian public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account.
I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the Namibian Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally.
I / We agree that although this Authority and Mandate may be cancelled by me / us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I / We acknowledge that this Authority and Mandate has been ceded to Farm Windhoek Adventure Tourism cc as per your agreement with Farm Windhoek Adventure Tourism cc , but in the absence of such assignment of the Agreement, this Authority and Mandate will be null and void.
I accept the above terms and conditions for a monthly debit order
Due to the nature of activities such as, but not limited to; hiking, mountain biking, dog walking, and bird watching in the picturesque but potentially dangerous terrain; by entering Commonage 2, you hereby unconditionally and irrevocably indemnify and exempt Commonage 2, its owners, staff, holding company, subsidiaries, directors, shareholders, employees or agents from any liability as to any claim, action, damages, inconvenience, loss, fatality, illness or injury to person or property of whatever nature, arising from your use of this property and/or presence within Commonage 2.
YOU HEREBY AGREE TO USE THIS PREMISES/LOCATION ENTIRELY AT YOUR OWN RISK AND TO ABIDE BY THE ‘RULES’OF THE FARM.
I accept the above terms and conditions