ADVENTURE TRAVEL AFRICA - Booking & Credit Card Authorisation form
1. Fill in, print out. 2. SIGN, FAX to ++27 12 343 9351. All Budget Operators charge 5 % bank charges for
processing credit cards on top of the stated price. This is charged by our greedy banks!
| Trip Name(s) | Trip Code(s) | Departure Date(s) |
| CLIENT 1 | CLIENT 2 | |
| Surname (Mr/Mrs/Ms/Miss) | ||
| First Name | ||
| Nationality | ||
| Place and Date of Birth | ||
| Passport No | ||
| Place of Issue | ||
| Date of Issue | ||
| Date of Expiry | ||
| Occupation | ||
| Address for correspondence | ||
| |
||
| Personal Email address | ||
| Insurance Company | ||
| Policy & Emergency number | ||
| Next of Kin | ||
| Name and Phone number | ||
| Meal Preferences if any | ||
| Health Notes |
| Payment Details - if transfer leave blank | ||
| Name of card holder: | ||
| Type of card | VISA | MASTERCARD |
| Card No: | ||
| Card expiry date: | (mm/yy) | |
| Last 3 digits: | (found on reverse of card) | |
| Total amount in RAND: | ||
| Today's date: | (dd/mm/yy) | |
|
I have read the booking conditions and accept. I hereby authorise Adventure Travel Africa or their appointed tour operator to deduct amount specified above from my credit card. |
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| Signature of credit card holder: | ||
| TripCost:_______________DepositPaid:_____________Local
Payment: US$_______
*Please note that there is a non-refundable deposit of ZAR4000 per person per trip to secure your booking. Final payment is due 8 weeks prior to departure. Bookings are non-transferable. I certify on behalf of the person(s) named on this booking form, by which I warrant I am authorised to make this booking, that I/we have read and agree to the booking conditions below relevant to my/our trip, and the conditions of insurance that I/we must take to travel on this/these trips. I declare that I am over 18 years of age and have read and understood the booking conditions. Signature1:___________________Signature2:__________________Date:__/___/____ |