Credit Card Authorization Form

cards
All information is kept confidential.

All credit card transactions are processed in our local currency the Namibian Dollar (N$) and based upon the exchange rate on the day of the transaction which can result in a monetary difference of more or less of the processed amount that you have authorized. By submitting or signing this form you are acknowledging and accepting that the amount that you will be charged may be slightly higher or lower in your currency than what the amount that you authorized to be processed which is beyond our control.

*required fields.

    Individual/Business/Group Name*

    I hereby authorize the following amount in US$ to be applied to the following credit card by Westfalen Hunting Safaris*

    Credit Card Type* (Visa, MasterCard and Maestro)

    Credit Card Number*

    Name as it appears on Credit Card*

    Credit Card Expiration Date* (mm/yy)

    Card Identification Code (CID)* (Visa, MasterCard and Maestro have a number in the signature panel on the back of the card, the last three digits are the CID code.

    Credit Card Billing Address*

    City*

    State

    Zip Code*

    Country*

    Phone

    Email

    Date* (mm/dd/yyyy)

    Signature of Cardholder* (Type Name)

    Please click on the Submit button to send this Credit Card Authorization Form to Westfalen Hunting Safaris so that we may process your credit card payment. After you click Submit you will be returned to the home page of this website. We will confirm with you reception of this form and payment processing within the next couple of days. Thank you.