Wicksons Travel
Holiday Booking Form
You can either fill this form in on your computer before you print it, or print it out and fill it in by hand. Please note, any information you fill in on your computer will be lost when the page is closed. Should you have any questions about filling in this form please call Wicksons Travel on 01543 372247.
Title Initial Surname Room type Special requirements
Destination
Departure date
Tour code
Would you like to take out insurance? Have you got your own insurance?
Yes No Yes No
If yes to your own Insurance, what is the name of your Insurance Company? :-
Name of next of kin: Contact telephone no.:
Address to which correspondence should be sent (Must be the cardholders' address if booking by Credit Card)
Postcode: Pick up point required
Tel No.
I have read the booking conditions and agree to abide by them (see bookings page on web site or below).

I enclose my/our Deposit of £25 per person (which is non-refundable) + Insurance (If required)
Total value:

I enclose my/our Full Payment + Insurance (if required)
Total value:

Signed on Behalf of all Party Members:

If booking 6 weeks or less prior to departure date, full payment is required...

I wish to pay by:
Access Mastercard Delta
Eurocard Visa

I authorise you to debit my account with the amount of:

My card number is:

Expiry date of card:

Last 3 numbers on back of Card:

(On signature strip)

Name (As on Card):

Cardholders' address:

Telephone No.:

Signature:
Please print this form out and send it to:

HOLIDAY BOOKINGS
WICKSONS TRAVEL
COPPICE ROAD
BROWNHILLS
WALSALL
WS8 7DG