Countrywide Cruisers - Booking Form
Countrywide Cruisers, The Wharf, Brewood, Staffordshire, ST19 9BG
Please telephone to reserve your boat Tel: +44 (0)1902 850 166   then complete this form on line, print it, sign it and send it with your vouchers to the address above.

1. Name and Address of Hirer

Title:

Initial:

Surname:

Address:

Home Phone No:

Work Phone No:

Email address:

2. Composition of Crew

Adults (No.):

Children Under 13 (No.):

Pets (No. and Type): (Not permitted on 5 Star Boats)

Names of Crew

1.

6.

2.

7.

3.

8.

4.

9.

5.

10.

 

3. Linen & optional extras
(This section helps us to provide the correct combination of linen for your party.)

Double Berth:

Single Berth:

 

 

Boating Video
(UK Only, £1.25 P & P):

Boating DVD
(UK only, £0.85 P & P)

Guide Book (Please use Order Ref:)

Guide Book
(Please use Order Ref:)

Offers/Discounts/Tokens you wish to claim:

4. Please Help Us

Have you cruised on a narrowboat before?
If so, with us?

Where did you hear about us?

5. Agreement to Hire

- I agree to pay the £45 Accidental Damage Waiver Fee with the balance of my Hire Fee.
- I declare that I am over 21 years of age.
- I agree to be held responsible for the balance of the hire fee which becomes due
  and payable on the date shown on my Booking Confirmation.
- I have read and agree to be bound by the Conditions of Hire.

Signature

Date

6. Choice of Boats and Dates

Hire Base:

Boat Name:

 

Starting Date:

Finishing Date:

Duration:

7. Your Initial Payment            Please make cheques payable to Countrywide Cruisers Ltd. .

There is no charge for Credit or Debit Cards.

Please charge to my Credit Card

  
 

Please...

 automatically from my Credit Card 6 weeks before the start of the holiday.

Card Type

Card Number

Valid from

Expiry date

Name on card

Switch Issue No

 

 

3 digit Card Security Code.

Cardholder’s signature only:

(On the back of your card)

If the signature is not that of the Hirer detailed above, 
please give Cardholder’s Name and Address below.

Title:

Initial:

Surname:

Address:

Post Code:
   Please print this form, then sign it and fax to: +44 (0)1902 851 662
or post to: Countrywide Cruisers, The Wharf, Brewood, Staffordshire, ST19 9BG