Booking Form PLEASE READ AND CONFIRM TERMS AND CONDITIONS TERMS AND CONDITIONS | Please click here! I Confirm that I read the Terms & Conditions Departure Date (required) Departure City (required) Destination (required) Consultant (required) MEMBER'S CONTACT DETAILS Full Name (required) Cell Phone (required) Membership Number (required) Home Phone (required) Residential Address (required) Email address(required) CONTACT DETAILS IN THE EVENT OF AN EMERGENCY (person not traveling with you) Full name (required) Relationship (required) Work Phone (required) Cell Phone (required) PASSENGER DETAILS: - Exactly as per Passport/ ID Passenger 1 Mr-Mrs-Ms: Surname 1: First Name 1: ID Number 1: PASSENGER 2 DETAILS: - Exactly as per Passport/ ID Passenger 2 Mr-Mrs-Ms: Surname 2: First Name 2: ID Number 2: PASSENGER 3 DETAILS: - Exactly as per Passport/ ID Passenger 3 Mr-Mrs-Ms: Surname 3: First Name 3: ID Number 3: PASSENGER 4 DETAILS: - Exactly as per Passport/ ID Passenger 4 Mr-Mrs-Ms: Surname 4: First Name 4: ID Number 4: PASSPORT INFORMATION 1 - Exactly as per Passport Passport Number 1: Expiry Date 1: Date of issue 1 Nationality 1: PASSPORT INFORMATION 2 - Exactly as per Passport Passport Number 2: Expiry Date 2: Date of issue 2 Nationality 2: PASSPORT INFORMATION 3 - Exactly as per Passport Passport Number 3: Expiry Date 3: Date of issue 3 Nationality 3: PASSPORT INFORMATION 4 - Exactly as per Passport Passport Number 4: Expiry Date 4: Date of issue 4 Nationality 4: I/We hereby confirm that I/we have read the above and confirm that all the personal details provided and travel details specified herein, are correct as per ID/Passport. PAYMENT DETAILS 1. Please take the time to complete all the information requested on this form. 2. The completion and return of this form will be accepted as full and final acknowledgement that all the personal information provided and travel arrangements made, are accurate. 3. By signing this booking form, you are deemed to have read, understood and agreed to the Global Travel Alliance Terms and Conditions and you agree to comply with them. 4. Documentation will not be issued without the required proof of payment forwarded to Global Travel Alliance. 5. Clear copies of the card holder’s valid passport/ID, as well as the front and back of the valid credit card, are required when payment is made by credit card. We accept the following credit cards: Diners, Visa, Master and American Express (for air tickets only). 6. A merchant fee of approximately 3,0% may apply for certain supplier payments made by credit card; please verify with your travel consultant. BANKING DETAILS FOR EFT PAYMENT PLEASE EMAIL PROOF OF PAYMENT TO YOUR RESERVATIONS CONSULTANT Account Name: EZT Membership Services (Pty) Ltd | Bank: Standard Bank Account Number: 071 957 928 | Branch Number: 051001 | Swift Code: SBZAZAJJ CREDIT CARD PAYMENT - CREDIT CARD HOLDER'S DETAILS FULL NAME AS PER PASSPORT OR ID ID NUMBER CELL PHONE NUMBER BILLING ADDRESS Name of issuing Bank Card Number CVV Expiring date Amount to be debited in Rand Budget/Straight I/We have read, understand and accept that I am/we are bound by the Global Travel Alliance Standard Terms and Conditions and where applicable, the conditions of the Supplier with whom my reservations are held. I am at least twenty-one (21) years of age, I am authorized to effect this reservation and accept the conditions applying thereto, on behalf of the travellers detailed above. Failure to comply with the above can result in travel documents not being released, and/or all bookings being cancelled and/or payments being forfeited.