Booking Form - South American Experience, London UK 0870 499 0683

Please fill out this form on-line

Print out your form, and sign

Include a deposit of £150 per person

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:
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 credit card details below.

There is no extra charge when paying deposits by credit card. However, if you are paying in full for your holiday or the balance, there is a 2.5% charge on credit card payments.

There is no extra charge on any payments made by debit cards.

Your Card Payment Details

Name
Billing address

Method of Payment

Mastercard:

Visa:

Switch:

Connect:

Debit card:

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

_______________________________________________________

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

Welby House
96 Wilton Road
Victoria
London SW1V 1DW

Tel: 0845 277 3366
Fax: 020 7821 4001