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Thank you to complete this form and finish by clicking on 'Print and Finish'. Status Identity : Mister Miss Misses Name : First name : Address : Zip code : City : State : Country : Phone : Mobile phone : Professionnal phone : Fax : Profession : Email : Birth date : Nationality : Marital status : Single  Married  Divorced  Widower  Indentity card/passport number : Validity date : Stay Date of arrival : Hour of arrival : Departure date : Number of persons : Adult : Child : Baby bed : yes  no      Breakfast : yes  no Participant Name :   First name :   Birth date : Genre : M  F      Name :   First name :   Birth date : Genre : M  F      Name :   First name :   Birth date : Genre : M  F      Name :   First name :   Birth date : Genre : M  F      Name :   First name :   Birth date : Genre : M  F      Payment Payment of the installment of an amount of Euros corresponding to 30 % of the total value of the stay. Payment : Payment by banking cheque to make out to « L'ARUM SARL » Payment by securised blue card n°    Expiration date : Installment I undersigned authorize « L'ARUM SARL » to output the sum of Euros corresponding to 30 % of the global value of the stay. At the Signature of the holder of the card : Payment for balance Payment of the pay of the total value of the selected stay, the day of arrival to the residence. Comment