CUSTOMER: Mr. Mrs.*Last Name *First Name *Street *City, State & ZIP/Postal Code *Country Tel. (+ area code) Fax (+ area code) *E-Mail PAYMENT: *Card Type Your Credit Card: MasterCard VISA *Card Holder *Card Number *Expiration Date Month 01 Jan 02 Feb 03 Mar 04 Apr 05 May 06 Jun 07 Jul 08 Aug 09 Sep 10 Oct 11 Nov 12 Dec Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MasterCard & VISA: Last 3 digits on the back of the card This is a legally binding reservation request and I authorize Blue Travel to disclose my personal information to Maui Motorhome Rentals . I give permission for Maui Motorhome Rentals to charge my credit card accordingly with the appropriate hire costs. I acknowledge that I am the authorized card holder of this account, have read the Terms and Conditions and agree to abide by them. RESERVATION: *Vehicle Type Please Select: Maui Economy Maui Spirit 4 Maui Spirit Delux *Rental Option Standard Rates Inclusive Rates *No. of Passengers 1 2 3 4 5 *Pickup Location Southern Africa Cape Town, South Africa Durban, South Africa Johannesburg, South Africa Port Elizabeth, South Africa Windhoek, Namibia Maun, Botswana Harare, Zimbabwe Victoria Falls, Zimbabwe *Pickup Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2012 2013 *Drop off Location Southern Africa Cape Town, South Africa Durban, South Africa Johannesburg, South Africa Port Elizabeth, South Africa Windhoek, Namibia Maun, Botswana Harare, Zimbabwe Victoria Falls, Zimbabwe One way charges apply.*Drop off Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2012 2013 Flight Details / Transfer Request ADDITIONAL COMMENTS: To make a reservation please click on the Send Reservation button above.THANK YOU for your business!