Reservation form Lares Machu Picchu 4 days

Departure date:
Date of arrival (Cusco): Time of arrival:
Flightnumber Lima/Cusco: Coming from:
(country of departure)

More than one person? Please fill out the form below for each of you.

Passenger 1 
First name Last name Passport number Nationality
Date of birth Age Telephone Email
Food-preference: vegetarian Include a sleeping bag (USD $ 16.00)
vegan
no preference
Concerning food, do you have any allergies?

Passenger 2 
First name Last name Passport number Nationality
Date of birth Age Email
 
Food-preference: vegetarian Include a sleeping bag (USD $ 16.00)
vegan
no preference
Concerning food, do you have any allergies?

Passenger 3 
First name Last name Passport number Nationality
Date of birth Age Email
Food-preference: vegetarian Include a sleeping bag (USD $ 16.00)
vegan
no preference
Concerning food, do you have any allergies?

Passenger 4 
First name Last name Passport number Nationality
Date of birth Age Email
Food-preference: vegetarian Include a sleeping bag (USD $ 16.00)
vegan
no preference
Concerning food, do you have any allergies?
 I / We will make a deposit to your bank using
(Do not send money yet, we will send you a request for payment):
(Details below)
 Paypal (Cheapest and fastest. If you have a creditcard you can use Paypal)
 Western Union (payment via internet)
 Rabobank (Netherlands)

How to pay

Paypal

Western Union

www.westernunion.com

Bank wire to our account in The Netherlands

RABO bank (our bank account in The Netherlands payment in Euro only):
Accountnumber: 39 45 96 986 P.A. Roos inz. Eco Tourism Chaska
IBAN (International Bank Account number): NL83 RABO 0394 5969 86
BIC  RABONL2U

The address of the bank:
RABO bank Noordwest Friesland
Oosterburen 70
8891GD Terschelling Midsland
Telephone +31 (030) 287 87 87

The address for P.A. Roos Inz. ECO Tourism Chaska:
Oosterburen 14
8891 GC Terschelling Midsland
The Netherlands