Booking Form

Full First Name:
Surname/Last Name:
Street Address:
City:
Country:	AlgeriaAmerican SamoaAndorraAnguillaAntigua and BarbudaArgentinaAustraliaAustriaBahamas, TheBahrainBarbadosBelgiumBelizeBermudaBrazilBruneiBulgariaCambodiaCanadaCape VerdeCaymand IslandsChannel IslandsChileChinaChristmas IslandColombiaCook IslandsCosta RicaCubaCypressCzech RepublicDenmarkEast TimorEcuadorEgyptEl SalvadorFaukland IslandsFiji IslandsFinlandFranceFrench GuineaFrench PolynesiaGermanyGibraltarGreeceGrenadaGuamGuernseyHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKenyaKiribatiKoreaKuwaitLebanonLiechtensteinLithuaniaLuxembourgMacau S.A.R.MalaysiaMaldivesMaliMaltaMan, Isle ofMauritiusMexicoMicronesiaMidway IslandsMonacoMoroccoMozambiqueNepalNetherlands AntillesNetherlands, TheNew CaledoniaNew ZealandNicaraguaNigeriaNiueNorfolk IslandNorthen IrelandNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaSaudi ArabiaSingaporeSouth AfricaSpainSri LankaSwedenSwitzerlandTaiwanThailandTongaTrinidad and TobagoTunisiaTurkeyUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaNot ListedUruguayVenezuelaVietnamVirgin IslandsVirgin Islands, BritishYemenYugoslaviaZimbabwe
Office Telephone:
Home Telephone:
Fax:
Mobile:
E-Mail:

Please enter your Driver's Licence Details:
Drivers Licence No:
Expiry Date:
Unrestricted M/C Licence?:	Please select optionYesNo
Current Motorcycle:
Approx No. of years Full motorcycle licence held:
Rider Height approx:
Rider Weight approx:	- Choose..LbsKgStone-Pounds
I will have a Passenger:	Please select optionNoYesStill working on it.

Bike Model:
Pickup Date:
at time: (specifiy am/pm)	(Normal Business hours apply)
from (depot):	Please Select Option Nelson Auckland Christchurch Other
Return Date:
at time: (specifiy am/pm)	(Normal Business hours apply)
to: (depot)	Please Select Option Nelson Auckland Christchurch Other
DailyRate: NZ$	/day
One Way Charge	Please Select Option Not required Required NZ$350 if one way, and less than 10 day hire.

Optional Excess/CDW Cover:	Please select an option.. CDW Cover for The Rider only CDW Cover for both Rider and Passenger I do not require CDW Cover Please send me a quote for CDW cover
Any information you'd like to provide regarding the Excess/CDW:

As a Hirer I am an experienced, responsible and healthy motorcyclist with a valid and unrestricted driving licence for the model requested
Name as it appears in your passport or NZ Drivers Licence:
Passport or NZ Drivers Licence number:
Email address:
Please type I ACCEPT in the box (must be in upper case ie. 'BIG' letters) as confirmation that you have read and understood the Terms and Conditions and other details

Deposit Payment:	Please select an option... Pay Deposit for 1 rental bike now (NZ$2000) Pay Deposit for more than one rental bike now (NZ$2000 per bike) Pay Full Rental Amount Now
Excess/CDW (NZ$4000):	Use credit card number supplied Or Not required as CDW insurance option taken
Final Payment:	Please select an option... Please autocharge the balance to my credit card when due Please contact me before billing my card for the balance I'll wire transfer the balance Other
VISA or Mastercard users.  Please provide the 3 digit PIN/Security Number found on the back of your card:
AMEX users. Please provide the 4 digit PIN/Security Number found on the back of your card:
..and your AMEX Card Issuing Bank
.... and Amex Billing Address please.
Your Name and Email Address:	Please let us know your name and email so we know who sent us the loot! As much as we like donations we prefer to be able to match cc details with real people :-)
Your Name:
Your Email Address:
Our Bank Details for Wire Transfer or Internet Banking. Bank: Bank of New Zealand (BNZ) Branch: Trafalgar St, Nelson, New Zealand Account No: 020704-0512311-00 Swift No: BKNZNZ22 Name of Account: Adventure New Zealand Motorcycle Tours Ltd Please, please, puhleeeeze.... ... include your name in the text line if you use the wire option! Bank Charges will be passed on if we need to track a payment.