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Authentication of Payment for Sponsored Ticket

BOOKING REFERENCE NUMBER:

CREDIT CARD HOLDER'S DETAILS:

Name:

Contact Numbers:

B):

H):

Cell:

Fax:

I.D. No.:

Passport Number:

Country of Issue:

CREDIT CARD DETAILS:

Credit Card Type:

Visa

Diners Club

Master Card

American Express

Name of Bank:

Credit Card No.:

Expiry Date:

M

M

/

Y

Y

Security No.:

(Last 3 numbers on back of credit card)

Amount to be Debited:

Currency:

Amount

Payment preference:

Straight:

Budget:

06 Months

12 Months

24 Months

Statement Billing Address (as per Bank):

PASSENGER'S DETAILS:

Name:

Contact Numbers:

B):

H):

Cell:

PASSENGER'S ID:

I _________________________________ hereby authorize SOUTH AFRICAN AIRWAYS to debit my credit card as detailed above.

__________________________ Cardholder's signature	_________________________ Date
PLEASE FAX THIS FORM WITH A COPY OF THE ID/PASSPORT & THE BACK & FRONT OF THE CREDIT CARD TO THE COUNTRY WHERE TRAVEL COMMENCES.

Our Fax Number within South Africa is: 011 978 2557 For any other country please visit www.flysaa.com AND Click Customer Support -> Contact Us -> Contact Offices Phone within South Africa: 0861 359722 International Callers: +27(11) 978 5313 Our Email Address: help@flysaa.com
**********PLEASE ENSURE ALL REQUIRED COPIES ARE ATTACHED***********