Absolute Adventure Africa Safaris Central Reservations Office
Portal Place Building Suite 308
P.O Box 11644 -00100 , Nairobi Kenya
Tel: 254 20 2190240 or 318300
Tele-Fax: +254 20 318300 or 248453
Cell: +254 722 495989
E-: info@absoluteadventureafrica.com http://www.absoluteadventureafrica.com

  

Absolute Adventure Safaris
Registered and Licensed Tour Operators in East Africa
 

Clients Name:

Date:
 

Services Required

Amount Payable: USS$

Travel Dates
Return Dates
 
Your Travel Consultant Name:
Please supply and confirm the following details for your credit card payment.
Print out and fax the form back to us. Please ensure that you sign the
form below before faxing.
 
Cardholders Name:
 
Credit Card Number:
 
Expiry Date: (Month/Year)
3 Digit Validation Code on Back of Card
(3 Digits on Visa/Mastercard, 4 Digits on Amex Card)
 
Address (Credit Card Billing Address):
 
Country:
 
Post Code/Zip Code:
 
Telephone:
 
Fax:
 
Email Address:
I (NAME) hereby authorize Absolute Adventure Africa Safaris to debit my credit card for the services detailed above for amount mentioned ONLY)
Signature: