Online Booking Form
 

Kindly complete and submit the online booking form and fax your proof of deposit payment through to:

+27 86 518 9649.

 
  Contact details:
     
  Tel (home):
  Tel (work):
  Cell:
  Fax:
  Email:
  Email2:
     
  Vehicle details
     
  Model:
  Make:
  Reg no:
  Trailer reg no:
     
  Safari:
 
   
  Dates:
 
   
  Passenger 1 (please fill in surname and full names as on passport):
     
  Surname:
  Full names:
  Nickname:
  Passport no:
  Nationality:
     
  Passenger 2 (please fill in surname and full names as on passport):
     
  Surname:
  Full names:
  Nickname:
  Passport no:
  Nationality:
     
  Passenger 3 (please fill in surname and full names as on passport):
     
  Surname:
  Full names:
  Nickname:
  Passport no:
  Nationality:
     
  Passenger 4 (please fill in surname and full names as on passport):
     
  Surname:
  Full names:
  Nickname:
  Passport no:
  Nationality:
     
  Passenger 5 (please fill in surname and full names as on passport):
     
  Surname:
  Full names:
  Nickname:
  Passport no:
  Nationality:
     
  Emergency contact details:
     
  Name:
  Relationship:
  Cell no:
     
  Would you like Explore Africa to facilitate a rental vehicle?
     
  Yes
  No
   
  Do you want Explore Africa to arrange your Insurance? If declined, you waver Explore Africa from any responsibility should anything happen to you while travelling.
     
  Yes
  No
   
  I have read and agree to the terms and conditions:
     
  Yes
   
 
Security Check: