Trek Booking Form - Wayfarers Himalaya Adventures

Trek Booking Form

Submit this form to book a Nepal trek

Please reserve * space(s) on the * trek

from * to *

* indicates a required field

in favor of the name(s) below.

#.	Last Name*	First Name*	Sex*	Date of Birth*	Occupation	Nationality*	Passport #*
1.
2.
3.
4.

Special/ Dietary Instructions (Please use serial nos. (#) from above table to indicate individually)

Medical Conditions (Please use serial nos. (#) from above table to indicate individually)

Preferred Hotel Category (only for a private departure)

Single Room(s)/ Tent(s) Required

Contact Information

Name *
Address
Daytime Phone	Home Phone
Fax	Email *

Payment Information

A booking deposit of US$ 100 per person is required to confirm a booking. The balance is due 60 days prior to trip commencement. Please indicate below your preferred method of payment.

Review Booking & Payment Conditions

I would like to pay the sum of * US$ as * Booking deposit(s) Full payment

* » I am sending an authorization to charge my MasterCard Visa American Express

For credit card payments, please fax us your card details with the amount of charge and signature.

» I am sending payment by Bank draft Telex transfer

Please make bank drafts/ telex transfers payable to Wayfarers Himalaya Adventures Pvt. Ltd., A/c # 01 04 21 17633 01, Nabil Bank Ltd., Kantipath, Kathmandu, Nepal. (SWIFT Code: NARBNPKA). After sending payment, please fax us a copy of the bank remittance advice.