Mevuot Hagalil
Order Form
Name
Sima & Zvika Keller
Host
Sima - Lodging
052-481600
04-6937562
FAX
CELLULAR
PHONE
Sima
Rosh Pina
Contect Man
Address
Must Be Filled
*
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Date
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Phone at Work
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Name and Surname
Phone at Home
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Fax
Cellular
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Address
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DepartureDate
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Special Requests
Cost of deposit
Cost of payment
Bank
Visa
Charge Credit-Card by Phone
IsraCard
Other
Credit Card Number
I.D.
Expiration Date
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Mevuot Hagalil