Today's Date: / / From: (name)_____________________________________________________ Postal address____________________________________________________ ___________________________________________________________________ _______________________ Country_________________________ e-mail address:________________@_________________ Telephone Number:__(_____)-____________________ Request :________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________ Amount Autorized to Charge to my Card $_________US Dollars Signature_____________________________ Date / / DD MM YEAR Card number GOOD THRU____ /____ BILLING ADDRESS______________________________________________ _______________________________________________ _______________________________________________ ________________________________________________ |
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| Fax to:VILLA BELMAR Hotel & Beach Club USA& CANADA Fax number (1) 954 317 3312 (USA-CAN -IT IS A USA. NUMBER) FROM ANY COUNTRIY ALSO DIAL (INTERNATIONAL ACCESS CODE ) 52 954 582 2520 |
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