1 Please fill out this form on-line 2 Print out your form, and sign 3 Include a deposit of £150 per person 4 Post it to us
Your Contact Details
Name
Telephone (Day)
Telephone (Eves)
E-mail
Address
 
 
 
Family Name First Name Title Nationality Date of Birth Age Passport No. Expiry
               

 

.
TOUR NAME:
DEPARTURE DATES  
First Choice:
Second Choice:
Third Choice:
Extensions:

Other Relevant Information
Person / Topic Information
   

Room Preference:
Single: Double: Twin
Confirm Your Travel Arrangements:

On behalf of all members of my party, I have read, understand and agree to all the conditions relating to booking and insurance and agree to pay the balance no later than 8 weeks before the departure date.

Signed: Date:

 

 

Your Total Payment:
Deposit:
Insurance:
TOTAL:

Please make cheques payable to "South American Experience Ltd" or complete details below:

 

Your Payment Details
Name
Address
 
 
Method of Payment
Mastercard: Visa: Switch: Connect: Delta: Amex:
Valid From: Expiry Date: Issue No. (Switch) *Security Code:

*Security code = last three digits on reverse of card

 

Card Number:


Cardholder Authorisation:
Please debit my card:
Cardholder's Signature

 

 

_______________________________________________________
ATOL protects your travel arrangements with us. Thank you for booking with us. Remember that your trip and your privacy are safe with us - we are members of ATOL.

South American Experience Ltd, 38-44 Gillingham Street, Victoria, London SW1V 1HU.

Telephone: 0870 499 0683