Fax Payment Form      

Please note that all fields are required * except for the Security Code which is only necessary for Amex cards. Once you have filled in your details please click print form at the bottom of page and fax it to Amatikulu Tours. If you do not know what a C.V.V code is, please click here
Amount: *  
R
 (South African Rands)
Proforma Invoice Number: *
First Name: *
Last Name: *
Email Address: *
Date of birth: *
Card Holders Name: *
As it is on the card
Street Address: *
City: *
Postal Code / Zip Code: *
Country: *
Credit Card Number: *
 Double Check
Expiry Date: *
     (Month, Year)
C.V.V: *
  Last 3 digits on back of Visa & Master Card
Type Of Card: *  Visa, MasterCard, Diners or Amex
Security Code:   Only American Express cards *
I hereby authorize Amatikulu Tours to debit the above amount from my credit card.
   
Signature
 
Please ensure that your information is filled in correctly before printing.
 

Please fax the printed form to Amatikulu Tours
International Fax: +27 86 5026503
National Fax: 086 5026503

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