Hlela Funeral Magazine subscription form Hlela Medial (Pty) Ltd, PO Box 505, Northriding, 505 / Tel (011) 431 0566 / Email: [email protected] Please enrol me as a subscriber to Hlela Funeral Magazine. My application is for 4 upcoming issues (1 per quarter) which should be posted to the address provided below. Name and Surname:…………………………………………………………………………………………………………………………………………… Postal Address: ………………………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………………………………………………… Tel:...........................................................email:..................................................................................................... OPTION 1 Please debit my bank account (details provided below) with the once of subscription fee of R50.00. Name of account holder:…………………………………………………………………………………………………………………………………… Name of Bank……………………………………………………………………Branch……………………………..…………………………………… Account number……………………………………………………………………………………………………………………………………………….. Today’s date…………………………………………………………………….Signature……………………………………………………………….. OPTION 2 I will do a direct deposit into Hlela Media’s bank account and email the proof of payment to [email protected].