Dear Sir
Thank you for your interest in garden hotel, however as you know, to confirm the reservation you have to pay a deposit (non-refundable) of $400 by printing and completing this form and sending it back by fax: (961-4-960259).
To print the form: Please right click the image below and select print in the popup menu that appears. 

Internet/Mail ORDER

 

Please write in BLOCK letters

1] SECTION TO BE FILLED BY THE CARD HOLDER

IDENTIFICATION

Family Name: _______________________   First Name: ____________________

Family Status:  ٱSingle ٱMarried ٱDivorced         Date of Birth:      /       /                      

Company Name: _____________________________________________________

Type of Business: _____________________________________________________

Full Address: ________________________________________________________

City: _______________________________Country: ________________________

P.O.Box: ___________________ Tel: ________________  Fax: ________________

DESCRIPTION OF SERVICE

1) _____________________________________      Amount (US$): ____________

2) _____________________________________      Amount (US$): ____________

If Hotel reservation, please mention duration of stay: from __________ till ________

PAYMENT MODE

MasterCard Visa  Card Number  ∟∟∟∟ ∟∟∟∟ ∟∟∟∟ ∟∟∟∟

Expiry Date:   --- / ---    CVC2/CVV:  ∟∟∟   (Please write the 3 digits printed on the signature panel on the back of the card) Issuer Bank _______________________________ Country: ____________

I accept the following terms and conditions:

I understand and admit that deposit is not refundable in all cases

I hereby certify that all the information given in this order request is true and correct to the best of my knowledge. By submitting this form along with a copy of my card and my passport, I fully authorize Merchant Name ____________________________ to bill my invoice to the above mentioned card without my prior consent for a total amount of US$ __________________.  This request is accepted by me and can not be revoked.

Name:  _______________________Date: _______________ SIGNATURE: _______________

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2] SECTION TO BE FILLED BY THE MERCHANT

Att:   Bank Audi Sal - Audi Saradar Group

          Electronic Banking & Card Services

          Merchant Section – Fax: 01-219960

Kindly execute this transaction under my full responsibility.

Merchant Name:_____________________  Authorized Signatory: __________________

Stamp & signature: ___________________      Date: __ __ / __ __ / __ __