| Name: _________________________ |
| |
| Telephone #: ____________________ |
Fax #: _______________________ |
| |
| e-Mail address: ____________________ |
| |
| Boat: ___________________________ |
No of Passengers: ___ |
| |
| Date of Charter: __/__/___ |
| |
| Type Of Charter: Private __ Shared __ |
Length Of Charter: 4 hours __ 8 hours __ |
| |
| Pickup Location (Hotel): _______________________ |
| |
| Pickup Time: _________________________ |
| |
| Amount: _________ |
| |
| Payment: MC ___ Visa ___ Dis ___ Amex ___ |
| |
| Credit Card #: ___________________________ |
| |
| Expiry Date:__/__/___ |
| |
| |
| ______________________ |
| Signature |
| |
Other Details:____________________________
|