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withdrawn 8 weeks prior to your holiday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