Mevuot Hagalil
Order Form
Name
Golan Winery
06-6964004
06-6962001
FAX
CELLULAR
PHONE
Kazerin
Contect Man
Address
Must Be Filled
*
To send by FAX please fill all the form and press Ctrl-P to Print
Date
*
Phone at Work
*
Name and Surname
Phone at Home
*
Fax
Cellular
*
Address
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
1
2
3
4
5
6
7
8
9
10
11
12
1999
2000
Arrival Date
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
1
2
3
4
5
6
7
8
9
10
11
12
1999
2000
DepartureDate
Babys(till 2)
1
2
3
4
5
6
7
8
9
10
Childrens (till 12)
1
2
3
4
5
6
7
8
9
10
Number of People
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Special Requests
Cost of deposit
Cost of payment
Bank
Visa
Charge Credit-Card by Phone
IsraCard
Other
Credit Card Number
I.D.
Expiration Date
Press Ctrl-P to Print
Mevuot Hagalil