NOM DE L`HOTEL : Château de Montvillargenne

Sapiens 2015 Client Conference
Château de Montvillargenne, Gouvieux, France
October 21-22, 2015
AUTHORIZATION FOR CREDIT CARD DEBIT
Payment for the accommodation and Breakfast from the 21 to the 22 of October 2015,
for an amount of 150 €
Please fill this form, sign it, and send it to Château de Montvillargenne, France by
e-Mail: [email protected]
IDENTIFICATION OF THE CREDIT CARD
Name of the credit card holder: ______________________________________________
Type of card: _____________________ Card number : ___________________________
Number at the back: _______________ Expiry date: _____________________________
Name of the guest: _________________________________________________________
Date : ______________________
Signature :__________________
Château de Montvillargenne – Avenue François Mathet – 60270 Gouvieux – Tél : 03 44 62 36 36 – Fax : 03 44 57 28 97
Email : [email protected] – internet : www.chateaudemontvillargenne.com
SA Château de Montvillargenne au capital de 500000 € - RC Senlis B 320 317 019
Château de Montvillargenne/Commercial/ADV/Janvier 2012 (version 1)