If you want to make a reservation for the apartment in Rome Casalpalocco,
please print this form on your printer, complete it in block-letters,
and send it to:
 
Dolly Steenbergen
Boterstraat 12
(NL) 6701 CW Wageningen
The Netherlands
 
Any questions? e-mail: rome@stonehill.nl. 

 
If possible, I would like to reserve the apartment in Rome Casalpalocco 
Date of arrival :                 Date of departure:
 
Name            :                 Phone/GSM        :
 
Initials        :                 Email address    :
 
Address         :                 Bank account     :
 
Zip code + City :                 IBAN             :
 
Country         :                 BIC              :
 
 
I have transferred the initial payment to bank account
92.33.27.258 of ING (IBAN: NL35 INGB 0923 3272 58; BIC: INGBNL2A)
in name of D.Steenbergen, Wageningen, the Netherlands and I am obliged
to pay the rest of the money upon arrival in Casalpalocco.

 
In case of TIMELY cancellation the advanced money
will be returned immediately to my bank account.
 
 
We travel by
( ) plane to airport Ciampino/Fiumicino/unknown
( ) car
( ) train
 
 
We are with       persons.
 
 
Dates of birth: .. - .. - .... ,
 
 
                .. - .. - ....
 
Date:                             Signature:
 
 
PS: After payment of the advanced money
you will receive a confirmation.