CAPE TO CAIRO, LLC: African Business and Adventure Travel

In lieu of my credit card imprint I _________________________________________
                                                        (Name of cardholder as shown on the Credit Card)
hereby authorize___________________________ or ______________________________
                          (Issuing Carrier, ie. SAA, BP, KLM, BA)        (Travel Agency Name, i.e. Cape to Cairo)

to charge my ____________   ______________________________ / ____________  / _________
                  Credit Card Issuer                           Credit Card Number                                   Expiration Date        3 or 4 digit code     

In the amount of $ ________________________for payment of myself
                                    (Print amount clearly)
                               (Full name(s) of passenger(s) if other than cardholder)
for itinerary as follows: __________________________________________________
                                                           (Routing: i.e. ATL-MIA-CPT -MIA - ATL)
Billing address:                                                                                                  Phone:


____________________________________________________________________    (H) ___________   


____________________________________________________________________   (O)____________      


Mailing address if different from billing:






Please list full names as in your passport/s and dates of birth for each passenger (required by TSA.)








NOTE: Identification is required. Please provide photostat copy of the credit card (Front & Back) and passport or drivers license of cardholder.

By signing below, I acknowledge charges described heron. Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing card. I understand that cancellation penalties may apply and the rebooking and refund policies are governed by terms and conditions provided with the written itinerary.


                        (Signature of cardholder)

This form must be submitted prior to ticket issuance. Incomplete Information or false statements shall be considered sufficient cause for denial of ticket.

Fax to Cape to Cairo at (202) - 244 - 5993