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 4096-bit SSL/TLS encryption!

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):