I would like to book an Italy vacation

First name:

______________

Id number

______________

Last name:

______________

Tel:

______________

Birth date:

______________

Fax:

______________

Nationality

______________

Occupation:

______________

Address

______________

Credit card no.:

______________

Expiry date:

______________

The house I like to book: _____________ from: _____________ to: _____________

In case the above house is unavalable, I would like one of the alternatives below:

___________________ ___________________ ___________________

Please add these Services (Rent-a-car, Motorhome, Hotel):

1) _______________ from: ____________ to: ____________

2) _______________ from: ____________ to: ____________

Signature: _____________________        Date: _________________________

I hereby agree to the terms and conditions.

Send the filled form by fax to: 972-4-9898188    or to; Italy fax : +39 6 80 85 749 Sng. Aizenman