Booking Confirmation

Online Confirmation Form

Fill out the form below, and your details will be sent to Pungalina via e-mail. We will e-mail you our account details so you can transfer your deposit. Note 2% surcharge on credit card transactions

Terms and Conditions

Please fill in this form to confirm your Booking at Pungalina:

Your e-mail address:

Total Number of Guests:

Name Address Phone Sex Age

 

Arrival Date: //     

Departure Date: //

Arrival Time (Northern Territory time):

Departure Time (Northern Territory time):

Arriving By:   at (Location) 

Cost per Guest: $

Total Cost for the Group on this Form: $

Special Requirements:

Health:  

Guest:

Limitation:

Guest:

Limitation:

Guest:

Limitation:


Diet:		  

Guest:

Limitation:

Guest:

Limitation:

Guest:

Limitation:

By sending this form:

I/We promise to pay the sum of $ being the deposit for the total amount indicated above. (You may send us a cheque, or check here to request our bank details for direct deposit.) Note 2% surcharge on credit card

I/We acknowledge the balance is payable 4 weeks prior to Departure, otherwise cancellation charges will apply.

I/We have also read and understood the Terms and Conditions from the link at the top of this form and agree to abide by them.

Date:  //

 

 

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