Full Name (Last, first):
Fax number:
E-mail address:
Postal address (to which your receipt will be sent):
Other relevant information:
If you are sharing a room and will arrive separately, names of the person sharing the room with you.
Hotel you wish to reserve a room in:
Type of room desired (Single, Twin, Double, or explain):
Bath or shower:
Date of arrival, and estimated time of arrival if you are going to arrive late:
Date of departure:
CREDIT CARD AUTHORISATION FORM
(please fill in the blanks)
I authorise Central Voyages to debit my credit card ________________
Nr _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , expiring on      /      , of the amount billed to
Central Voyages by the Hotel ___________
Name as it appears on the card
Date Signature
Please fax this form to:
Central Voyages
29, rue du Pont-Neuf
75001 Paris
France
Fax: 33 1 42 36 29 33
Please note: This authorisation form is to be used ONLY in case you choose a hotel of the 1st list. This form should NOT BE USED for hotels in which you make the reservation yourself.