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| FAX HOTEL RESERVATION FORM
The Palmyra
Hotel |
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| FAX HOTEL RESERVATION FORM
The Palmyra
Hotel |
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Please legibly print or type and fill out completely.
| LAST NAME |
FIRST |
M.I. |
| COMPANY OR AFFILIATION |
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| Mailing address (tick one): [ ] HOME [ ] BUSINESS | ||
| STREET |
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| CITY |
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| ZIPCODE |
COUNTRY |
|
| TELEPHONE |
FAX |
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| E-MAIL |
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| DATE |
SIGNATURE |
|
HOTEL RESERVATION FORM (Check appropriate boxes) |
|
| 1. [ ] I wish to book ____ single room(s) at 14 JD/night | TOTAL ___________ JD |
| 2. [ ] I wish to book ____ double room(s) at 20 JD/night | TOTAL ___________ JD |
| 3. From ____day September ____ to ____day September______ | |
| TOTAL AMOUNT DUE | ___________ JD |
| TOTAL AMOUNT REMITTED : (1 NIGHT DEPOSIT) | ___________ JD |
| In order to guarantee your room reservation a one night deposit is requested, which can be done by charging your credit card | |
| Charge my (tick one): [ ]Visa [
] Euro/Mastercard [ ] American Express [ ]Diners CARD NO: __ __ __ __ : __ __ __ __ : __ __ __ __ : __ __ __ __ EXP.DATE: __ __ / __ __ |
|
| Authorizing Signature: |
Page created by Philippe Geril. Last update 18-08-04.
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