Credit Card Charge Authority
DIVERSION DIVE TRAVEL
PO BOX 191, Redlynch (Cairns), QLD 4870
ph:+61 740390200, fax +61 740 390 300
booking terms and conditions

Personal Details:
First Name
/Initial: 		 *
Last Name:
 *
Address:  *
City:
 *
State:  
Zip/Area Code:
 *
Country:  *
Email:
  *
Phone:  *
Fax:
 
Payment Details:
Card Type:
Name of card holder:
 *
Card Number:  *
Expiry Date:
 /  *
mm       yyyy
Card Sequence No.:  
(3 to 6 digits - usually on back of card)
Issuing Bank:
 *
Service:
Billing Address Of Card Holder: (if different from above)
Address:
City:
State:
Zip/Area Code:
Country:
 
Phone:
Fax:

 We strongly recommend comprehensive travel insurance cover.
*
More information on online travel insurance

Fields marked * need to be filled or selected

"By sending this credit card authorisation, I confirm that I know and acknowledge the booking terms and conditions and authorise DIVERSION DIVE TRAVEL
to use the above credit card to pay for travel services purchased by me."