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Tour Name

Reservation Number (if applicable)

Your Booking Agent Name (if applicable)

Travel Agency Name (if applicable)

Travel Agent Name (If applicable)

First Name

Last Name

Agency Address (If applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agency Email (If applicable)

Phone

(###)

###

####

Passenger Names

Credit Card Authorization

Kindly complete and send this form along with a clear photocopy of front and back of the related credit card and cardholder’s driver’s license to verify signature. Please fill name as shown on your credit card. I, hereby authorize Savitar Tours to debit my credit card for travel expenses in the amount indicated.

Select Card Type

Amex

Visa

Master

Discover

Credit Card Number

Expiry (month/year)

Security Code

Billing address (same as for your credit card)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Amount

Discount Code (if applicable)

Authorization

I waive my right to dispute these charges. I have read the terms, conditions and cancellations policy and agree to same. In signing this reservation form, I/we accept the Conditions as set forth in the brochure/ flyer or website on behalf of all those listed above. We also declare that we have been offered trip cancellation insurance and that I/we will not hold the travel agent, Savitar Tours nor its agents responsible for any expenses incurred. I/We understand that should I/we cancel my/our tour, my/our deposit is non-refundable.

Date

YYYY

Signature

E Brochure

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