Martyrs Bus Service

First name

Last name

Title (Mr/Ms/Mrs)

School/Organisation

Address

Suburb/Town

Postcode

Work Phone

FAX

E-mail

BILLING

Purchase order # (if applicable)

A.B.N. (if applicable)

POSTAL ADDRESS FOR INVOICING

Postal address

(cont.)

Postcode

	Choose one of the following options:
	I wish to book a charter I wish to obtain a quotation
	What day, date and time would you like the charter? (for multiple dates leave these fields blank and include all date details in "special requirements" box lower on the form)



	pickup time is; (eg 9:10AM) and final drop or back-by time is; (eg 3:00PM)
	Please include all details for your charter. What is the pickup location? (if specific entrance or bay please state)

	What is the destination? (include any relevant details)

	what time are you boarding for your return journey? (eg 2:10PM) How many passengers under 12 years of age? How many passengers 12 years of age and over? Do you have any special requirements or requests? Luggage? Commentary? Accessibility? etc. Also use this box to include details of multiple (repeat) bookings if applicable.

I agree to the Terms & Conditions.

30 Kellys Road
Warburton 3799
p. (03) 5966 2035
f. (03) 5966 5955


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