Active Safaris Western Australia Booking Form

Booking and Payment Form
Active Safaris

PO Box 230
Como 6952
Western Australia
Australia

Telephone: +61 (08) 9450 7776
info@activesafaris.com.au

This booking form is sent via a secure server 256 bit encryption

Secure booking system.
Every effort has been made to protect your details, when you send us a booking we use 256 bit encryption technology which is one of the most secure ways of transferring sensitive information over the Internet.

Pricing:
All Pricing is in Australian Dollars and we accept Visa, Master Card and Bank Transfers.

* denotes a required field

Your Details
Full Name*:
Address:
E-mail Address*:
Phone Number*:
Fax Number:
Concessions
Do you have a concession card?	Yes No
If Yes please select one from the list:
If Other please specify:
Card Number:
Tour Details
Select Tour:
Departure Date (dd/mm/yy)
Number of Adults
Number of Concessions
Number of Children (Under 12)
Dietary Requirements:	Standard Vegetarian Other…
If Other please specify:
Please specify any health concerns:
Pickup From:	Central Pickup Hotel or Hostel
If Hotel or Hostel please specify:
Payment Details
Credit Card Type:*
Credit Card Number:*	- - -
Name on Card:*
Expiry Date:* (mm/yy)	/
3 Digit CCV Number on reverse (Credit cards only):	View Example
Amount:*	All payments in Australian Dollars
I agree to the Terms and Conditions*	to Terms and Conditions
This booking form is sent via a secure server 256 bit encryption Planet Perth Tours / Active Safaris sensitive information policy We will never knowingly pass any of your details to a third party for the purpose of market research, client profiling or indirect mailing campaigns. Peace of Mind. Active Safaris / Planet Perth Tours are members of Tourism WA and Accredited to theTourism Council of WA. Accreditation provides the consumers with an assurance that businesses are committed to professionalism both in operations and delivery of service and that the company is carefully monitored. Always look for the tick when booking a tour in Australia. Please also note we are one of the very few operates in Western Australia who hold a current Australian Travel License with membership to the Travel Compensation Fund. So if we are unable to deliver you are assured of a refund. Our Travel License Number is 1TA1384. � Copyright 2007 All Rights Reserved