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 International Office 
United Kingdom + 44 (0) 1491 574455
Name of card holder:
 
Card number:
 
Type of card (Master, Visa, etc):
 
Name of bank:
 
Expiry date:
 
Last three digits on reverse side of card:
 

Total: R

35% deposit payment: R

65% final payment: R

 
Birth date of card holder:
 
Billing address:
 
Passport nationality: Passport number:
 
Collection details:
 
Drop off requirements:
 
Any special dietary requirements:
 

I hereby authorise Safari Rangers, their agents to debit my credit card covering the 35% deposit to secure my safari. The final payment of 65% to be debited from my same credit card fourteen (14) days prior to my safari departure date.
 
DATE: ________________ SIGNATURE _________________________
 
Please fax this filled out form off to our International Office 
United Kingdom + 44 (0) 1491 574455
 

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