APPLICATION FORM for MOTO TOUR No. Click Here to Enter Text

APPLICATION FORM

APPLICATION FORM FOR MOTO TOUR No. [Click here to enter text]

·  The date of the Moto Tour who start the [Click here to enter text]

·  The name of the Moto Tour is [Click here to enter text]

·  The full price of the Moto Tour is [Click here to enter text] EUR

PERSONAL DATA:

·  First name: [Click here to enter text]

·  Family name: [Click here to enter text]

·  Telephone number (full with state number): [Click here to enter text]

·  Passport or ID number: [Click here to enter text]

·  Driver's license number: [Click here to enter text]

·  Driver's license categories: [Click here to enter text]

·  Blood type and Rhesus factor: [Click here to enter text]

·  Date of birth: [Click here to enter text]

·  E-mail address: [Click here to enter text]

My motorcycle is:

·  Mark: [Click here to enter text]

·  Model: [Click here to enter text]

·  Km on counter: [Click here to enter text]

·  Plate number: [Click here to enter text]

I DECLARE THAT:

-  i Confirm my engagment on the moto tour Nr._____ with a payment of 70% of the full amount. I SEND IN ATTACHMENT THE PROOF OF PAYMENT.

-  The remaining 30% , I will pay at the latest 15 days before the scheduled start of the tour.

-  I certify that I have a valid insurance that provides me the NECESSARY MEDICAL assistance in case that I needed.

-  The insurance policy issued by: [Click here to enter text], policy number: [Click here to enter text] issued on: [Click here to enter text] - EXPIRES: [Click here to enter text]

NOTE !

[Click here to enter text]

This is where you can enter all the important remarks like: I want to be alone in a double room, I'm a vegetarian...... or whatever you consider important for your comfortable stay on the tour by Moto you have selected. Note: your comments may affect the total cost of Moto Tours you choose, so keep this in mind!

This Application is made in [Click here to enter text], the Date [Click here to enter text]

______

Signature of the Applicant

*The application form, filled and signed with the document who prove the payment, scan and send on the mail C.A.S. –

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