Blue Travel, Inc.  -  RESERVATION FORM  -  Lodge / Hotel in South Africa
            Please fax to USA Toll Free: 1-877-605-6888 or
   United Kingdom: +44-208-711-5331  |  Germany: +49-3222-690-6222
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CUSTOMER ADDRESS:                                        (please print)
                :  ___ Mr.   ___ Mrs.
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       Last Name:  _____________________________________________________
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      First Name:  _____________________________________________________
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          Street:  _____________________________________________________
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            City:  _____________________________________________________
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      State, ZIP:  _____________________________________________________
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         Country:  _____________________________________________________
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    Phone Number:  _____________________________________________________
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      Fax Number:  _____________________________________________________
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          E-Mail:  _____________________________________________________
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PAYMENT:
       Card Type:  ____ MasterCard      ____ VISA      ____ Diners Club
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                   ____ American Express     ______________ ID
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     Card Holder:  _____________________________________________________
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 Full Cardnumber:  _____________________________________________________
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 Expiration Date:  ____/____ 
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This is a legally binding reservation request and I authorize
Blue Travel to disclose my personal information to the requested
lodge / hotel. I give permission for the requested lodge / hotel to
charge my credit card accordingly with the appropriate costs for all
reservations requested herewith. I acknowledge that I am the authorized
card holder of this account, have read the Terms and Conditions and
agree to abide by them.
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RESERVATION:
Lodge / Hotel: _________________________________________________________
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 Arrival Date: ____ / ____ / _____   Departure Date: ____ / ____ / _____ 
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 No. of Rooms: ______                 No. of Guests: ______ 
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Special Requests (e.g. Dietary etc):
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ADDITIONAL COMMENTS:
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____________________________________ ___________________________________
City and Date                        Signature