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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 :or transfer the deposit
*Card Number:No dashes or spaces please
*Expiration Month:From your card
*Expiration Year:From your card
*Card Brand:
*CVV2:3 digits (back of card-right)
*Pay in :
*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:
*Check out date:
Check in at 14:00- change to:if possible
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
Need a crib for baby?
Yes
No
Comments:Special request
Short term rental agreement
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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