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Fax Reservation
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First Name _______________________________________________________________________ Last Name________________________________________________________________________ City, Country _____________________________________________________________________ E-mail ___________________________________(necessary to confirm) Date of Arrival__________________________________ Hour AM__________ or PM__________ Date of Departure________________________________ Quantity of persons:____________ adults, ______________ Childs. Room (s): Single Room Double Room Triple Room Price sigth to screen:_______________________________________________________________ 1. Type of Credit Card_______________________________ 2. Number _________________________________________ 3. Expiration Date __________________________________ 4. Name of Card Holder ____________________________________________________________ |
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EASTER ISLAND Simon Paoa s/n / Phone-fax: (56-32) 100593 |
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