Title  Mr /Mrs/Miss
Surname
E-mail
Address
Postcode / Zip Tel 

Choice of boat

1st   2nd
Choice of date
1st   2nd
Number of weeks
Total in party                children under 12yrs
I heard of you from
Signed
I am over 18

Payment (if your holiday is less than 8 weeks the full payment is required) you may pay by cheque, cash or credit card.
Only a 25 % deposit is required. You may pay in full if you wish.

Total boat hire
Compulsory damage waiver
Total holiday cost
25% deposit
Optional cancellation scheme
Total deposit enclosed
If paying deposit full payment will be withdrawn 8 weeks   prior to your holiday                                                                

  My card number is:

Valid from
Expires
Switch card number

Cardholders signature

Empress Holidays Ltd, Basin End, Nantwich, Cheshire, England. CW5 8LA
Please make cheques payable to Empress Holidays Ltd