Africa Centre Credit Card Authorisation Form - Master / Visa
Please PRINT, COMPLETE, SIGN and FAX to: (+27 86 6000 383 / +27 86 5874 730) or SCAN and email (firstname.lastname@example.org) to us together with a copy of the front and the back of the authorised credit card.
NOTE: Please put what the payment is for - Type of Accommodation + Date of Arrival / Tour Name and Date of Departure / Number of People
Card Holders Name
Last 3 Digits on Back of Card
Card Expiry Date
NOTE: Please put what payment is for - COMPANY / TOUR CODE & DATE / TIME OF DEPARTURE
I hereby authorise Africa Centre International CC to debit my Credit Card. I am aware that a 5% administration charge will be levied.
Total Rand Amount
Rand Amount in Words : ZAR
Please PRINT, COMPLETE, SIGN and FAX to: +27 11 894 4857