Dates :
Surname:
First Name :
Street and number :
zip code :
City :
State :
E-mail :
Phone num. :
Fax num. :
Order confirmation:
e-mail
post
Payment:
form payment: a) post :
b) bill :
bill number:
Name of Bank :
Date from:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
year
2005
2006
2007
2008
number of night
number and type requirements rooms:
Two beds room :
Three beds room :
Number of person :
Number of children :
Children age :
Other room - what type :
Number other room :
Other date if Penzion Zákon is full :
Other question or comments :
Please check your order before send.
Thanks for you order