Today's Date: / / From: (name)_____________________________________________________ Postal address____________________________________________________ ___________________________________________________________________ _______________________ Country_________________________ e-mail address:________________@_________________ Telephone Number:__(_____)-____________________ Request :________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________ Card number GOOD THRU BILLING ADDRESS______________________________________________ _______________________________________________ _______________________________________________ ________________________________________________ |
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| Fax to: VILLA BELMAR Hotel & Beach Club Fax (011) 52 954 5822520 (USA-CAN ) FROM OTHER COUTRIES , ENTER YOUR INTERNATIONAL ACCESS CODE |