CHARGE CARD FORM

After filling this form, please print it, sign it  and fax it to the following number: 254 (20) 210592

REF:  AUTHORITY TO DEBIT YOUR CREDIT/CHARGE CARD

I hereby authorize Pinnacle (K) Travel and Safaris Ltd, P.O. Box 44162-00100, Nairobi to debit my card for US$ in payment of

My details are:

Names:   
Address:

City, Post Box, Country: Select one Kenya Uganda Tanzania USA Canada Belgium

Card Type: VISA MASTERCARD

Card Number:
Expiry Date: 
Passport/ ID Number: 

My contacts are:

Work Phone:
Home Phone:
Fax:      E-mail: 

Signature:  ___________________Please note:

• Once the payments have been effected, we shall post the clients copy to you for your records.

• The card company will go through their regular procedure to obtain authorization, and in doing so they may contact you personally for verification details