Please use this secure form to send us all your details for the cruise that you have a booking confirmation for. If you have not already done this, please use our simple booking request form to check on availability and reserve a space.
If you are not comfortable submitting this information electronically, simply print out this page fill it out and fax is to us at: (679) 336 1137
Cruise date:
Contact Details:
Address:
City:
State:
Postal Code:
Country:
Phone 1:
Phone 2:
Diving Experience:
Number of Dives:
Certification Level:
Brief description of your diving experience:
Medical Conditions:
Please describe any medical conditions related to diving:
Dietary Requirements:
Please describe any special dietary requirements you have:
Other Requirements:
Please describe any other requirements you have:
Payment Details:
You can use these methods to pay for your cruise:
Send Bank Cheque to our address below.
(Fax it to us first at: (679) 336 1137)
Wire transfer the funds into our bank account
(contact us for details at sere@connect.com.fj)
Fill out you credit card information below
From your confirmation email you would have been informed of the minimum payment amount required.
Credit Card Information:
Amount:
I authorise the above amount to be charged to my credit card:
Mastercard VISA American Express
Card Name:
Card Number:
Expires:
Mollie Dean Cruises Holdings Ltd.
PO Box 3256, Lami, Fiji Islands
Ph: (679) 336 1171 Fax: (679) 336 1137
Email: sere@connect.com.fj
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