Fax Number: (+48 22)  652 21 13

HoteliGo.pl

Fax Reservation Form

Personal Information

Name & Surname

Address

City

Phone

Street

Fax

Zip-code

E mail

Invoice Information

Company *

Stump*

Company Address

City

Phone

Street

Fax

Zip-code

E mail

TAX number

Business No

Reservation Information

Arrival date

Number of Nights

Hotel

City

Room Type

1 person

2 person

3 person

Apartament

Other

Number of Rooms

Additional Information

Payment Type (only in the case of a comfirmed reservation )

Credit Card**

Type

Number

Expiry date

Surname on Card

Number CCV

Bank transfer**

Please send confirmation of bank transfer

 to fax number 22 6522113 **

Account number(for paymenet by EURO)

82103010160000000007164029 Bank Handlowy S.A. I O/Warszawa

Account number(for paymenet by USD)

13103010160000000007164010 Bank Handlowy S.A. I O/Warszawa

Signature