Palau Splash Dive center
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Reservation
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Palau Pacific Resort
Dive Reservation
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Personal Information
Name*
E-mail*
How many are in your party?*
Diver:
Non diver:
Phone:
Fax:

Guarantee Information
Credit Card to secure bookings only. No charges made unless necessary.
Name on Card*
Accepted Cards* We no longer accept American Express.
Card Number*
Expires on* /
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Travel Itinerary
Where are you traveling from?
Arrival Date*
Flight #
(MM/DD/YYYY)    
Departure Date*
Flight #
(MM/DD/YYYY)    

Hotel Information
Hotel Name*

Activities
When and what are you interesting in doing with our shop
while in Palau?*
Palau Splash
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P.O. Box 847 Koror, Republic of Palau 96940 Phone: (680) 488-2600 Fax: (680) 488-1741
Copyright (c)2013 Splash. All Rights Reserved.