Excursions  Reservation  Form 

Date of Departure

/ /

Excursions : 

PASSENGERS DATA
Passenger  sex name surname age nationality
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No 2
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No 5
No 6
No 7
No 8

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*Name:

Fax:

*E-mail:

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*Telephone:

Mobile Phone:

Address:

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PAYMENT   DATA
I authorize Paleologos Shipping and Travel Agency to charge my credit card :
Credit Card
Name on Credit Card
Card Issue Date
Card Expiration Date
Credit Card Number

ATTENTION VISA-MASTERCARD & AMERICAN EXPRESS OWNERS!
According to the VISA and MasterCard International Organisations, the three (3) digits verification number following your card's number at the back of your card, by the signature.  American Express owners should check your four(4) digits verification number in the front of your card. (see example), is ABSOLUTELY NECESSARY
in order to complete a mail order.
Please insert your verification number in the box bellow.

Credit Card Verification Number :

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