dive directory
Please fill out this form and print it out.
Once printed, sign the bottom and fax to +61-7-40311210.
No information will be recorded or sent by filling this form out.
fields marked with * are mandatory
*Card holders name:
*Your email:
Your phone:
Your fax:
*CREDIT CARD NUMBER:
 - - -
*EXPIRY DATE mm/yr:
 /
*CREDIT CARD TYPE:
*AMOUNT AUTHORISED:
 AUD$
Trip you are booking:
Room Type:

Names:
Please indicate full names of all people travelling and certififcation level
Special Requirements:
Preferred trip start date:
 Dive Trip
Pick up from:
*Card Holders Signature:
  
Date:
    /              /    
 (dd/mm/yy)
I authorize Dive Directory to take a (25%) deposit at the time of booking and the vessel TAKA Dive Adventures to take the balance (75%), 30 days prior to departure.

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