Credit Card
Authorisation
fax to: +27 (0) 42 234 0787
|
I, being
____________________________________ the legal and rightful card holder of Credit Card(Visa/Master/American Express) number _____________________________________________________________ CVV (last 3 digits) ______________, and Expiry Date ________________ hereby authorise Hitgeheim Country Lodge to debit the said credit card account with a 50% deposit of the total accommodation cost. In the event of this reservation being cancelled within 14 days of arrival date, I understand that the 50% deposit will be retained by Hitgeheim Country Lodge and that a further 50% will be depited from my card account if the reservation is cancelled within four days of my arrival date. Details of Reservation Arrival Date: ____________________________________________ Departure Date: __________________________________________ Total: ____________________________ night's accommodation. Total Accommodation Tariff: ______________________________ 50% Deposit: _____________________________________________ Card Holders's Signature: ________________________________ Date Signed: _____________________________________________ Hitgeheim Country Lodge Tel: +27 (0) 42 234 0778 Fax: +27 (0) 42 234 0787 E-mail: hitgeheim-addo@agnet.co.za / info@hitgeheim-addo.co.za Website: http://www.hitgeheim-addo.co.za/ |