On-line Booking via Secured Form

Cyclande

 

This form is encrypted to protect your personal and credit card details.

When form is filled -in , you can save the booking details to your hard disk or print out a hard copy.

Please ensure you have completed all required sections before transmitting. Leave the N/A (Not Applicable) showing where services are not required.


1) Your personal details

First Name:
Last Name:

Male / Female

Male

Female

Your E-mail
Street Address :
Street Address (continued):
City:
State/Province:
zip / Postal Code:
Country:

Telephone (day)

Telephone (evening)


 

2) Participants Details

 

Please enter details of every participant (including yourself)

First name

Last name

Male / Female

M

F

M

F

M

F

M

F

Age

Bike renting

Your  Height (when bike renting)

Feet Inch

Or Centimeters

Feet Inch

Or Centimeters

Feet Inch

Or Centimeters

Feet Inch

Or Centimeters

Special Diet or Medical Condition

 

Are there also other people who will travel with you and who will pay separately?

If yes, how many?

and what are their names? (They will have to fill-in a separate application as they will pay separately)

 


 

3) Tour details

 

Activity :

Tour type :

Tour ref. :

- -

...or Tour name

Tour Start Date (day of welcome)    :

Are you flexible with this date?

 If yes,+/- how many days   before     after

Rooms requirements

Double room

= 1 bed for 2 people

Double

Twin room

= 2 separate beds

Twin Room

Single room

One room per person (extra charge applies)

Triple room

= 1 bed for 2 people, 1 bed for 1 person
Triple 

 


4) Selection of method of payment

Card

 

Card Type

Card Number: - - -

Expiration date:

 End ...

 

I authorize Cyclande to debit the deposit amount now

I authorize Cyclande to debit the due balance within 45 days of the tour start

Check : to "Cyclande" (Address : Cyclande, le Bourg, 46100 Beduer, France)

Wire payment: we will transmit to you wire payment references


5) Comments

Any comment? :

Please tell us how you first heard about Cyclande:

Before sending the form, make sure that you, as well as all the other participants for whom you are booking, have read and agreed all the booking conditions.

 If possible, we suggest you to print a copy of this form for your records


You attest the following:

"I have read and am authorized to agree on behalf of myself and all the participants of my party to accept the booking conditions of Cyclande as printed on this website. I am over 18 years old".