Balloon Rides, Hot Air Balloon Flights, Florida, South Florida, Air Travel, Etc.

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Online Form:	Use this handy, secure form to request a reservation by filling in the spaces below. When you click the submit button your information will be encrypted and sent securely to us.
Call:	Please call (954) 344-9522 and we'll confirm space to you directly and personally over the telephone.
Fax:	(954) 344-8763 and we can confirm space to you via fax or the telephone within one business day.
E-Mail:	Info@windsweptballoons.com. We will accept Visa or MasterCard to hold your reservation. We will confirm your reservation within one business day.
Mail	Deposit checks and correspondence should be clearly marked and sent to: Windswept Balloons P.O. Box 9652 Ft. Lauderdale, Fl. 33310-9652

Date Requested:

mm/dd/yyyy

Number of Passengers:

	Name	Weight
1.
2.
3.
4.

Your Name:
Your Address:

City:

State:

Zip:

Daytime Phone:
Evening Phone:

Is This A Surprise?
Children Ages 6-12?
Number of Children:

Billing Information

Card number

Exp.

Name on Card:
Billing Address:
City:
State:
Zip:
E-Mail:*

Name as you would like it written on the certificate:
Example:	Example:
To: Bill & Mary Jones	From: Debra & Jack

Special Requests:

Preferred Date(S) of Flight:

If certificates are mailed to a different location from above, please complete this mail to portion:
Name:
Address:
City:
State:
Zip:

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