dive directory
Please fill out this form and print it out.
Once printed, sign the bottom and fax to +61-7-40311210.
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fields marked with * are mandatory
*Card holders name:
*Your email:
Your phone:
Your fax:
*CREDIT CARD NUMBER:
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*EXPIRY DATE mm/yr:
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*CREDIT CARD TYPE:
*AMOUNT AUTHORISED:
 AUD$
Accommodation you are booking:
Please include preferred bedding configuration and names of all guests
Special Requirements:
*Preferred check in date:
 No of nights: Stay #1
*Preferred check in date:
 No of nights: Stay #2
*Preferred check in date:
 No of nights: Stay #3
Arrival method:
 
*Card Holders Signature  
Date:
    /          /    
 (dd/mm/yy)

By sending this credit card authorisation, I confirm that I know and acknowledge the booking terms and conditions and authorise DIVE DIRECTORY to use the above credit card to pay for travel services purchased by me.

No information will be recorded or sent by filling this form out or printing it.