Aqua Action Dive Center - Online Reservation Form

Please complete this form and click the "submit" button at the bottom to submit your request.

It MUST then be confirmed by us via phone or e-mail!!   Responses to the items in red are required for reservations.

This is a secure form using 256-bit SSL/TLS encryption! (Note: This page works best with Internet Explorer)

Check our current dive and rental equipment prices.    Click here to see our Stay and Dive packages!

Having problems with this form? Would you rather FAX or e-mail us a paper form? Click here

Questions? Send us an e-mail or give us a call at (888) 775-6285 or (340) 775-6285

Note: If you do not receive a response, please make sure that is on your Safe Senders (or White) List so that we can contact you by return e-mail!

Name:        Where are you staying?         

     Special Request(s)/Comments:  

Phone Number:                   E-Mail Address:           Re-enter E-Mail Address:  

Request Type:               Have you been diving in the last two years?:  Yes  No

Number of People:                                                       Experience Level:   

Are you (or if a group, is everyone in your group) SCUBA certified?  Yes   No

Date of Visit/Excursion/Dive (First Day if a Dive Package):           Equipment Needed:             

A credit card (or SHBR Confirmation Number) is required for purchases or to hold a reservation.

Your card will not be charged until you check in or your merchandise ships!

Credit Card Type:                  Credit Card Number:               CVV Code:    

Expiration Date: Month:      Year: 20          Billing Zipcode:                Name as it appears on card:       

  I have read and agree to the Aqua Action Cancellation Policy (applies to Credit Cards only)

  I have reserved a Secret Harbour Stay and Dive or Stay and Snorkel Package (applies to SHBR packages only)

SHBR Confirmation Number (only required for Secret Harbour (SHBR) Snorkel/Dive Packages):