Fax to +48.22.652.21.13 (Poland) or +1.310.601.1881 (USA)

 

 Guest Information:

 Last Name (Surname or Family Name):

      

 First Name:

      

 Middle Initial(s):

      

 Street Address:

      

 Daytime Phone #:

 (   )      

 City:

      

 State:

      

 Zip (Postal) code:

      

 Country:

      

 Evening Phone #:

 (   )      

 E-mail address:

      

 Fax #:

 (   )      

 

 COMPANY INFORMATION: (only necessary if an invoice is required for a reservation being made by a company on behalf of an employee)

 Company Name:

      

 Phone # (include extension):

 (   )      

 Company mailing address:

      

 Fax #:

 (   )      

 City:

      

 State:

      

 Zip (Postal) code:

      

 Country:

      

 Company Stamp:%

 

 Contact Person (person making and authorizing the reservation):

      

 Tax number†:

      

 Business number†:

      

 E-mail address for Contact Person:

      

 

 Reservation InformatioN: (‡)

 Arrival Date (MM/DD/YY):

      

 Number of nights:

      

   Smoking

   Non smoking

   No preference

 Special request / Additional information:

(e.g. number and ages of any accompanying children – and whether they will be staying in parent’s room)

     

 Hotel name:

      

 City:

      

 Room type:

1 person

2 person

3 person

Apartment

Other (specify)

 Number of rooms:

     

     

     

     

      

 

 Payment Information: (§) (only provide once reservation is confirmed)

 CREDIT CARD

 Type of Credit Card:

      

 Credit Card Account #:

      

 Expiration date:

      

 CVV Code (¶):

      

 Cardholder’s Name (exactly as on card):

      

 Cardholder’s Signature:

 Credit Card Billing address: (if different from mailing address provided in Guest Information section above)

      

 City:

      

 State:

      

 Zip (Postal) code:

      

 Country:

      

Phone # (on file with Card Co.):

 (   )      

 BANK TRANSFER (Please fax confirmation of bank transfer to +48.22.6522113 [Poland]  or  +1.310.601.1881 [USA])

     Account number for payment in EURO:

 82103010160000000007164029 Bank Handlowy S.A. I O/Warszawa

     Account number for payment in USD:

 13103010160000000007164010 Bank Handlowy S.A. I O/Warszawa

Notes:

†    Required only if VAT invoice needed

%   Optional

‡    Confirmation of reservation will be made within 24 hours on weekdays and 48 hours on weekends.

§    Reservation must take place a minimum of 3 nights prior to first night’s stay

©2005, Polandstay.com; All Rights Reserved.  09/24/2005
 
    "Card Verification Value Code".  Also known as CVC, CVV2 (Visa), CVC2 (MasterCard), or CID (American Express) number.  A security feature consisting of a three- or four-digit code for "card not present" transactions. This number is printed on your MasterCard & Visa cards in the signature area on the back of the card (it is the last 3 digits AFTER the credit card number in the signature area of the card). For American Express cards, you can find your four-digit card verification code on the front of your card above the credit card number on either the right or the left side of the card.