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First name:

Surname:

Address:

Zip code:

City:

Country:

Phone:

Fax:

E-mail:

Room type:

Date of arrival
(dd/mm/yy):

Date of departure
(dd/mm/yy):

Number of nights:

Payment
Master card CB JCB VISA American Express Diner's Club	Card Number: Expiration Date:

I've already been to the hotel:

Yes No

If Yes, invoice or reservation no.:

I want to receive the hotel's specails rates by mail : Yes No

Comment �i�p��܂��͕��ł��L��j: