Reservation Form via Fax: Fattoria Le Mandrie di Ripalta
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Client Information: Name on Credit Card: ______________________________________________________ Address1:______________________________________________ Address2:______________________________________________ Apt# :_______ City:___________________________________ State:_____________ Zip:_________ Country:________________________ E-Mail: _____________________________________________________ Telephone (very important):___________________________________________ Fax: __________________________________________________ Please note that at the moment of your reservation we require as confirmatory deposit an advanced payment of 30% of the entire amount of the stay. Card: [Visa __] [Mastercard__] [American Express__] Card# __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ expiry date : ______/_____ Signature:_________________________________________________ Type of apartment ( 1, 2 or 3 room ) Special requests: _____________________________________________________
Via Mandrie, 22 – Loc. Molino del Ponte |