429-430 Royal Exchange, Old Bank Street

advertisement
429-430 Royal Exchange, Old Bank Street
Manchester M2 7EP
Tel: 0161 839 111; Fax: 0161 839 0000
E-mail: [email protected]
ABTA
V1178
BOOKING FORM & PASSENGER DETAILS
Rome, Italy – with Jane Chipperton
DATE OF DEPARTURE: 1 MARCH 2016
TITLE
FIRST NAME
SURNAME
DATE OF RETURN: 6 MARCH 2016
PASSPORT NUMBER
DATE OF BIRTH
INSURANCE
NATIONALITY
IF NO – NAME INSURER
& EXPIRY DATE
Address:
Tel:
Day:
Eve:
Mob:
Emergency Contact Name & Address:
Tel:
ACCOMMODATION
SPECIAL REQUESTS
NOT GUARANTEED
Room Type
Twin*
Single
No of Rooms
*Name of person with whom you are sharing
Please detail below what you wish to pay for:
Deposit: £400.00 per person
Or full amount if travelling within 8 weeks
Travel insurance premiums:
UK RESIDENTS ONLY
19-65 £28.07 ; 66-69 £41.60 ; 70-74 £51.74
£
£
£
DEPOSITS
INS PREMIUM
TOTAL ENCLOSED
After 14 days of issue, we cannot refund the premium of your travel insurance policy.
How do you wish to pay?
INSTALMENT PAYMENTS ARE ACCEPTABLE.
I wish to pay by CHEQUE / POSTAL ORDER / CASH / CREDIT CARD (Cheques should be made payable to β€œITS”.)
If paying by credit or debit card then please complete the details below:
(Note that there will be a charge of 2.5% on credit cards only.)
Card Type: Mastercard / Visa / Amex / Switch / Solo / Delta (please delete)
Sec
No
Card Number
Valid from:
/
Valid to:
/
Name on card:
I agree on behalf of person names shown on this booking form to accept the Booking Conditions (where applicable) and warrant that I have the authority
of all persons named to make the booking subject to these conditions. This tour is subject to English Law. The Booking Conditions and details of travel
insurance are as per current ITS brochures and are freely available on request. I acknowledge that they contain certain exclusion clauses and I accept
them on my own behalf and on behalf of all other passengers named above. (Note: Bookings will only be accepted by persons over 18 years of age.)
Finally ...
Please sign here:
Actionstrike Ltd
Date:
Reg. No. 2613382 England
VAT Reg. No. 560 4413 67
Download