Help us design your vacation by completing the following form.

The information you provide will assist us in customizing your vacation and will be treated confidentially.
Additional information is usually required to prepare a customized quote and usually requires a phone call - this personal contact enables us to fine-tune arrangements to suit your requirements, and results in a more accurate quotation. We are happy to combine wine and other touring requests. If you are a resident of Australia or New Zealand, we will forward your request to our partners in the appropriate country to give you the best prices.

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Please complete the following form, adding any special details.
Required input * please.

First name*

Last name *

Title (Mr./Ms./Mrs.)

Street address

City *

State/Province *

Zip/Postal code

Country

Phone Number *

FAX

E-mail address *

Number traveling

Departure date Day MonthYear

Return date Day MonthYear

Home city or airport

Flights First class Business Economy

Transport Private car Self-drive Group
Combination

Hotel Choice 5 Star 4 Star 3 star Boutique hotel
B&B Apartment Combination

Wine Regions
Australia New South Wales
Victoria
South Australia
Western Australia
Tasmania
Queensland

Wine Regions
New Zealand North Island               South Island
Auckland                    Marlborough/Nelson
Hawke's Bay/Gisborne Waipara
Wairarapa                  Otago

Special Requests

Other areas of interest Ayers Rock Great Barrier Reef
Other

Have you visited Australia or New Zealand before? Yes No

When should we call you to discuss your itinerary? Time of day? *
US Time zone? *
How did you hear about us?

WINE TOURS AUSTRALIA & NEW ZEALAND

PO Box 927136, San Diego Ca 92192-7136

Tel: 858-550 9696

e.mail: mike@winetoursaustralia-nz.com

In conjunction with Down Under Answers CST: 207623340

First name*
Last name *
Title (Mr./Ms./Mrs.)
Street address
City *
State/Province *
Zip/Postal code
Country
Phone Number *
FAX
E-mail address *
Number traveling
Departure date	Day MonthYear
Return date	Day MonthYear
Home city or airport
Flights	First class Business Economy
Transport	Private car Self-drive Group Combination
Hotel Choice	5 Star 4 Star 3 star Boutique hotel B&B Apartment Combination
Wine Regions Australia	New South Wales Victoria South Australia Western Australia Tasmania Queensland
Wine Regions New Zealand	North Island South Island Auckland Marlborough/Nelson Hawke's Bay/Gisborne Waipara Wairarapa Otago
Special Requests
Other areas of interest	Ayers Rock Great Barrier Reef Other
Have you visited Australia or New Zealand before?	Yes No
When should we call you to discuss your itinerary?	Time of day? * US Time zone? * How did you hear about us?