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Choquequirao reservation form

I want to make a reservation for the Choquequirao 5 day trek
Departure date for tour to Choquequirao (Tuesday or Friday):
Date of arrival (Cusco): Time of arrival:
Flightnumber Lima/Cusco: Coming from:
(country of departure)
Number of participants:

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

(we need this information in order to request your trekking permits)

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 , 5 days)
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 , 5 days)
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 , 5 days)
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 , 5 days)
vegan
no preference
Concerning food, do you have any allergies?
I / We will make a deposit to your bank using:
(Details below)
Paypal (Cheapest and fastest, use if you book less then 30 days in advance. If you have a creditcard you can use Paypal)
Western Union (payment via internet)
Rabobank (Netherlands)
Comments/ requests:

How to pay

Bank wire to our account in Peru by

www.westernunion.com

Bank wire to our account in The Netherlands

RABO bank (our bank account in The Netherlands):
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