Heart of England Balloons Booking Form

Heart of England Balloons
Cross Lanes Farm
Walcote, Nr Alcester
Warks B49 6NA

TEL: 01789 488219
FAX: 01789 488336

You can use this form to send your details to us ...

You can fax it to us on 01789 488336.

You can post it to us, together with your cheque, postal order or credit/debit card details,

at :- Heart of England Balloons,
Cross Lanes Farm, Walcote, Nr Alcester, Warks, B49 6NA,

If you do not receive confirmation of your order from us, please be sure to check with us that it arrived.

If paying by credit/ debit card you can call us on 01789 488219

(A signed Booking Form must follow all telephone orders)

Please provide your details, (as the person making the booking):

Title
Name
Street address
Address
Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL

 Passengers  Details:-

 First Name
Surname
Age
Weight
Postal code
Home Phone
 First Name
Surname
Age
Weight
Postal code
Home Phone
 First Name
Surname
Age
Weight
Postal code
Home Phone
 First Name
Surname
Age
Weight
Postal code
Home Phone

Would you like to book a Flight ... ?

Yes No

Would you like to buy a Gift Voucher ... ?

Yes No

Vouchers are valid for 12 months. The recipient may then exchange the voucher for a flight booking. The flight must be taken before the expiry date of their Gift Voucher.

You can provide the following details or send a cheque with you order or we can call you to confirm the payment details

Would you like us to call to arrange payment ... ?

Yes No

BILLING INFORMATION
Creditcard
Cardholder name
Card number
Expiration date

You can choose to fly from one of the following locations, you should be aware that all primary launch sites are subject to wind direction and airspace limitations and that there may be a need to re-locate to a secondary site in order for a flight to be possible:

Stratford upon Avon *
Peak District in Derbyshire *
Stow on the Wold *
Banbury *
Warwick *
Worcester *
Evesham *
Cheltenham *
Tewkesbury *

Enter your preferred flight date ... : Please remember this will depend on the weather.

-- dd/mm/yy

Choose one of the following options to let us know which time of day you would prefer to fly:

AM
PM

Is this a Surprise ... ? (This is a required field)

Yes No

Please let us know the date when you will be presenting your Gift...: 

-- dd/mm/yy

Do you suffer from any significant Medical Condition or Disability? (Please see Clause 32 + 33 in the terms and conditions) ... ?

Yes No

I confirm that I have read the Terms and Conditions. (This is a required field

Please tell us how you heard about us in the space provided below. (This is a required field)





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