HOTEL BOOKING FORM

Surname

Name

Address

City

Country                      Zip

Tel.

Fax

Mobile

Hotel      2stars        3stars        4stars      4stars top (Hotel Le Conchiglie)

Room/s        N°........single      N°........double      N°........triple

Arrival date:             for lunch       for dinner        After dinner

Departure date :

Booking:       Full board     Half board      Bed & Breakfast

Payement by Credit Card N°

- Consent to use personal information. The undersigned, hereby allows his/her personal details to be used, in full knowledge of the information in Article 10 of the law 675/96, according to the reciprocal obbligations derived from this act, and therefore expresses his/her consent for the use of his/her personal details. -

Date

Signature