Aqua Adventure Order Form

ORDER NOW! AQUA ADVENTURE MORNING SNORKEL-SNUBA TRIP

PRICE REFLECTS A $10 DISCOUNT ON ADULT SNORKEL/SNUBA
REGULAR RETAIL PRICE FOR ADULT/SNUBA IS $144.

THIS IS A SECURE ORDER FORM

Our Price:

Number of Adults snorkel/snuba	at $ each -	Total: $
Number of Children snorkel/snuba	at $ each - 8 yrs or older.	Total: $
Number of Adults Snorkel Only	at $ each -	Total: $

Number of Children Snorkel Only	at $ each - (ages 4 - 12)	Total: $
Children under age 3 insert number in box:	No Charge for under 3 but you must include number of free children in your order.
Prices include all taxes, harbor fees and fuel charges, if applicable. GRAND TOTAL: $

Requested Activity Date Alternate Date

Your Name
Arrival Date on Maui (mo/day/year): Departure Date:

Where staying Unit/Room (if known)

Phone Where Staying (if known) Cell Phone

Credit Card Information

Type of Credit Card

Full Name As It Appears On Card:

Card Number (please include spaces)

Exp Date (month/year): Auth. Code (3 or 4 digits on back of card)

Billing Information

Street Address:

City State Zip Code Country

Home Phone Business Phone

Your Email Address

If you have questions or comments, please enter here:

CANCELLATION POLICY: No refunds on cancellations made within 48 hours of event on Internet orders. A 5% charge cancellation charge may apply. No refunds on "no-shows". If the activity cancels for any reason, you will
receive a full refund.

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