Baz Bus Booking Form

Baz Bus Booking Form - If you prefer, download and print out this document in Word Format and fax the completed form to Back In Africa on (+27) 86 614 3115
Name:
Surname:
E-mail:
Contact address:
Telephone number & country code:
Fax number & country code:
Residential Country:
Travelling partner`s name and surname:
Passport Number:
Nationality:
Partner's E-mail
Selected Ticket Option One way or Return Travel Pass
Departure From
If other selected from Departure - specify here:
Departure from Hostel:
First Hop off at:
End Destination:
If other selected from End Destination - specify here:
Requested departure date:
Amount of tickets you would like to purchase:
Where did you hear about the Baz Bus?
Payment:
Card type Visa Mastercard	(Please note 5% admin fee)
Credit Card Number
Last 3 digits / CCV on the back of card
Expiry date
Cardholder Name
Passport Number of card holder
Nationality of card holder
Amount Currency converter
Select currency	R (ZAR - South African Rands) or € (Euros)

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