Booking/Credit Card
Payment Form

 
South African banks require the following details in order to process foreign credit cards.
Please print off this form, fill it in and fax it off to our Reservations Office for processing 
United Kingdom + 44 1491 574455
Name of credit card holder:
 
Card number:
 
Type of card (Master, Visa, etc):
 
Name of bank:
 
Expiry date:
 
Last three digits on reverse side of card:
 

Deposit = R

Final Payment = R

Total = R

 
Birth date of card holder:                                                      Passport number of card holder:
 
Billing address:
 
Type of safari:                                       No of days:                                   No of persons:
 
Collection date:
 
Collection details:
 
Drop off date:
 
Drop off requirements:
 
Any special dietary requirements:
 
Fly-in safari option - We require the following information for us to issue flight tickets:

Passengers Full Name

Passengers Passport Number

1
 
2
 
3
 
4
 
5
 
6
 
 
4X4 safari option - Expedition Safari & Wild Camp Holiday                                                         

Drivers Full Name

Driving Licence Number

4x4 course certificate holder
1
 

Yes/No

2
 
Yes/No
3
 
Yes/No
4
 
Yes/No
5
 
Yes/No
6
 
Yes/No
 

I hereby authorise Safari Rangers SA, their agents to debit the above credit card covering the deposit to secure this safari.
The final payment to be debited from this same credit card fourteen (14) days prior to the safari departure date.
 
DATE: ________________ SIGNATURE _________________________
 
Please fax this filled out form to our Reservations Office for processing 
United Kingdom + 44 1491 574455