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Secure Reservation Form
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
*E-Mail:
Billing Information
*First Name:
Same name as on your card
*Last Name:
*Street and number:
Where your statement is mailed
*City:
Town
*State/Country:
*Zip Code:
*Phone:
Deposit/credit card Information
*Way to pay :
please choose the way you wish to pay
by credit card/paypal
transfer to Payoneer account
By bank transfer (please email me bank account details)
By credit card -details over the phone (please email me your phone #)
we email you the invoice
*Card Number:
No dashes or spaces please
*Expiration Month:
Month
January
February
March
April
May
June
July
August
September
October
November
December
From your card
*Expiration Year:
Year
2015
2016
2017
2018
2019
2020
2021
2022
From your card
*Card Brand:
Choose a Card
American Express
Master Card
Visa
*CVV2:
3 digits (back of card-right)
*Pay in :
choose currency
US$
Euro
Shekel
*Deposit amount US$ :
20% of total
*Deposit amount EUR :
20% of total
*Deposit amount ILS :
20% of total
Rental information
*Apartment number:
1
2
3
4
5
6
one form for each apt.
*Check in date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2016
2017
2018
2019
2020
2021
2022
*Check out date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2016
2017
2018
2019
2020
2021
2022
Check in at 14:00- change to:
if possible
*Leaving date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2011
2012
2013
2014
2015
2016
2017
Check out at 11:00- change to:
if possible
*Number of person:
including children
*Rent total amount US$ :
As qouted (for all period)
*Rent total amount EUR :
As qouted (for all period)
*Rent total amount ILS :
As qouted (for all period)
*Rest of payment :
Total payment minus deposit
*Rest of payment ILS :
Total payment minus deposit
*Rest of payment :
Total payment minus deposit
Balance will be paid by cash or credit card until 3 days before leaving
*Need car parking?
Yes
No
If available
Want an Israeli prepaid cell phone?
Yes
No
If available
want a regular line phone?
Yes
No
If available
Need a crib for baby?
Yes
No
Comments:
Special request
Short term rental agreement
Terms and Conditions
Checkout : Renter will return the keys to landlord . For lost key renter will pay $75 (replacing the lock expenses)
Indemnification: Renter releases landlord from liability for and agrees to indemnify landlord against losses , incured by landlord as a result of (a) Renter`s failure to fulfill any condition of this agreement; (b)any damage or injury happening in or about rental or premises to renter`s invitees or licensees or such person`s property; (c)Renter`s failure to comply with any requirements imposed by any govermental authority; (d) any judgment ,lien, or other encumbrance filed against renter as a result of renter`s action.
Entire agreement:This agreement and any attached addendum constitute the entire agreement between the parties and no oral statements shall be binding . It is the intention of the parties herein that if any of the rental agreement is invalid, for any reason,such invalidity shall not void the remainder of the rental agreement.
Failiure of landlord to insist upon compliance with the terms of this agreement shall not constitute a waiver of any violation.
Renter
I have read the foregoing agreement and by marking ``I agree`` and submitting this form, I agree to its terms (as if I sign it).
*I agree
Please note: The apartment is reserved for you only after we charge your deposit and email you receipt and confirmation.
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