Viking Deposits

Name

Prefix

First Name

Last Name

Phone number

Address

Post Code

Today I would like to pay:

A $100 per person deposit (see number of travellers below)

Other Amount

Donation

Do you want to donate $5 per person to support Animals Asia?

Number of travellers on this booking

Who was your Consultant today?

If known

Are you an existing client to Phil Hoffmann Travel?

Yes

Do you have a prefered Consultant?

Leave blank if you have no preference

Notes

(your consultant may wish to add a note here)

Payment Method

Credit card

Cash

Payment

Name on card

Card number

Expiry

Security code

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Cash payment code

Please see PHT staff

Terms and conditions