Information Form

In order to serve you in the best way,
we need to get to know you first.

To book your holiday with us, you should first complete this
information form and e-mail it to us
Within two days you will receive all the information.

Name:
Address:
City:
Zipcode:
Country:
Phone day:
Phone evening:
E-mail:
Fax:
Choice of country:	Spain South Africa
Choice of hotel or apartment in Spain:
Supplements? Breakfast Half board Full board
The length of your stay:
The date of your stay from - till:
1st choice from	Till
2nd choice from	Till
Choice in South Africa:
Self drive holiday Group travel: 7 Days 12 Days
City of departure:
Number, name and age of persons travelling with you:
1. Name Age
2. Name Age
3. Name Age
4. Name Age
Do you need rental equipment:
Transfer in: Self propelled wheelchair or Motorized wheelchair
Will you require a shower/WC chair? Yes No
Your weight:
Your height:
Your age: