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Credit Card Fax Form Hotel Reservation Guarantee Room reservation

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Credit Card Fax Form Hotel Reservation Guarantee Room reservation Powered By Docstoc
					            4TH BELGIAN HEART RHYTHM MEETING
    THURSDAY, 30TH SEPTEMBER AND FRIDAY 1ST OCTOBER 2010
                     BRUSSELS, BELGIUM

                          Credit Card Fax Form

                      Hotel Reservation Guarantee
Payment of hotel accommodation is to be made to the reception upon departure
from the hotel. In order to secure your hotel reservation, please complete this
form and send it to Downtown Europe by fax + 32 3 736 89 30.

Title           Mr           Ms

Family name ………………………………………………………………………………………………….……

First name ………………………………………………………………………………………………….……….

Company/Organisation …………………………………………………………………….…….……….

Address ……………………………………………………………………………………………………….……….

City code ………………………………..… City …………………….………………………………………….

Country ………………………………………………………………………………………….……………………..

Telephone …………………………………………..….. Fax …..…………..…………………………………

E-mail …………………………………………………………………………………………………………………….



Room reservation at Sheraton Brussels Airport Hotel
From ……………………………… to ……………………………



Credit card details
Credit card company

  Visa          Eurocard/Mastercard        Diners        American Express

Credit card number …………………………………………………………………………………………………

Expiration date (month/year) …………………………………………………………………………………

Name credit card owner ………………………………………………………………………………………….




Date ………………………….           Signature credit card owner…………………………….………..

				
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