credit card payment form

Please print this form and fax it to us as follows:
Fax from within Australia: (03) 5356 4970
Fax from overseas: +61 3 5356 4970
(Note: If you do not have access to a fax machine, please send the following details spread over two or more emails. Or you may phone on 03 5356 4971 between 8.00am and 8.00pm Eastern Australian time.)
 

I authorise the following payment to be made to Auswalk Pty Ltd.
 

Please charge my:      Visa  ___        Mastercard ___
 

Card Number:
 

Cardholder’s Name:
 

Expiry date:
 

Amount (in Australian dollars):
 

If you are paying the deposit now, would you like us to charge
the balance payment to the same card on the due date?          YES / NO

(If so, please check that the card's expiry date will still be current)  
 

Cardholder’s signature:
 

Date:
 

Name of walking holiday:
 

Starting date of walking holiday: