Penzion Coupé - Reservation

Notice: Highlighted printed data is necessary to fill in.

Choose term		Personal information
Date of arrival:		First Name:
Date of departure:		Surname:
		City:
Number of persons and reserved rooms		Street:
Number of persons:		ZIP code:
Number of rooms:		Telephone:
	(four double rooms and one trippleroom )	E-mail:
	(four double rooms and one trippleroom )	State:
Protection against spam		Company:
Please, write out the code:		Fax:

Note: