Person making the booking
 

First Name

Last name

Address  .  .

Country	Telephone (home):
Telephone (Work)	Fax:
Mobile Phone :	E mail address :

 
 Choice of cruise Please reserve for me the following. 
 

Boat range
Departure date	Return date
Departure Base : Le Somail	Return Base : Le Somail

 
Basic Cost of Hiring the Boat
 

Basic hire cost for the boat rental

A

Payment of deposit 
 

To confirm my booking, I enclose a deposit of 40% of the hire price.  (=A*40%) For bookings made less than 6 weeks from the start date the full hire price must be made.	B
Please reserve for me ........... bicycles at 40 Euros per week	Payable at base on departure
I would like to order ........... Waterways guide (s) at 27 Euros including postage and packing	C
Non-returnable Damage Waiver 75 euros (Narrow Boats) or 94 euros (Wide Beam Boats)	D
Total to Pay in Euros:	B + C + D
I am making my payment in one of the following 3 ways:	Please circle the payment method applicable

1: By cheque payable to h2olidays

2: By bank transfer to h2olidays

3: By credit card  We accept Visa, Eurocard or Mastercard

In this case of method 3  I authorize you to charge my account with the sum of .................................Euros 
 

Card Number:	Expiry Date
Date:	Signature

 Party Members 

 I will be accompanied by the persons listed below 
 

Name	Address
1	1
2	2
3	3
4	4
5.	5
6.	6
7.	7
8.	8
9.	9

 I have read the Conditions of Hire as published at http://www.barginginfrance.com/minervoisconditions.htm and agree to be bound by them 
 

Date

Signature