In lieu of my credit card imprint I _________________________________________
(Name of cardholder as shown on the Credit Card)
hereby authorize Cape to Cairo,LLC or its designated agent or
assignee
to charge my _________________________________ /
_____________ / ______________
(Credit Card Name/Credit Card Number)
(Expiration Date)
(3 or 4 digit security code )
In the amount of $ ________________________for payment of land arrangements
(Print amount clearly)
for myself and/or_______________________________________________________________
(Full name(s) of passenger(s) if other than cardholder)
for safaris and tours as follows: __________________________________________________
__________________________________________________________________________
__________________________________________________________________________
My billing address:____________________________ Phone: (Home) ____________
____________________________
(Office)_____________
____________________________
____________________________
I understand that the above land arrangements are prepaid, and that any deposits or payments may be partially or fully forfeited in the event of cancellation or no-show. I understand the risks inherent in international travel and understand that I am strongly advised to take out trip cancellation/disruption and medical insurance through a standard provider of such insurance. By signing below, I acknowledge charges described hereon. Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing card. I have read and acknowledge the Terms and Conditions of Cape to Cairo, LLC.
X___________________________________________
(Signature of cardholder)
NOTE: Identification is required. Please provide photostat copy of
the credit card (Front & Back) and passport or drivers license of cardholder.
TRAVEL AGENCY VALIDATION
For Agency Accounting:
APC#
Remarks:_____________________________