L'ARUM SARL - Résidence de tourisme** Les Acacias - Route de Krautergersheim - F-67870 Bischoffsheim
Tél : +33 (0)3 88 50 28 89 - Fax : +33 (0)3 88 50 78 81 -
contact@acacias67.com
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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.
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