----------------------- Fax Form - www.assisionline.com -----------------------

HOTEL 
Le Grazie

Gestione :
Hotel Le Grazie della Elidra Srl
via Madonna delle Grazie, 11
06088 - Santa Maria degli Angeli (PG) - Italia
Tel. (+39) 075 8043850
Fax (+39) 075 8043851

Thank you for visiting our Home-Page. 
If you wish to book a room for your holiday or want further informations PRINT this form, FILL IT OUT (in block letters) and SEND IT via fax.

NAME _________________________________   SURNAME __________________________________

*Company ____________________________  Address ______________________________________

City ___________________  ZIP_________  State _____________  Country ___________________

Int. code _____ Ph. __________  Fax: _____________  E-mail ________________________

1) DATE OF ARRIVAL _____________  2) DATE OF DEPARTURE ____________________
ROOM TYPE:
SINGLE ROOM Bed & Breakfast   number  ______
Half Board   number  ______
Full Board   number  ______
DOUBLE ROOM Bed & Breakfast   number  ______
Half Board   number  ______
Full Board   number  ______
**Information Request ________________________________________________

______________________________________________________________________
CREDIT CARD
VISA MASTERCARD DINERS AMEX
     
N. ___________________________________ EXP. _________(MM/YYYY)
CREDIT CARD HOLDER:

NAME ____________________ SURNAME ________________________

1) Room available from 12,00 o’clock 2) Leave the room within 10,00 o’clock * Optional. ** Please send the receipt of the bank transfer along with the fax.