Art-Hotel Mokhovaya /

Please, fill carefully the form below. All fields are mandatory.

Cardholder First name:

Cardholder Last name:

Card Type:

VISA Master Card Diners Club JCB

Card number:

Expiry date:

Passport №:

Phone/Fax:

E-mail:

Date of Arrival at Art-Hotel:

(dd/mm/yyyy)

Date of departure from Art-Hotel:

(dd/mm/yyyy)

This authorization covers the services outlined below:

DESCRIPTION	AMOUNT
Visa support fee (25 EUR per Invitation Letter)*	EUR
First night’s stay prepayment**	EUR
TOTAL:	0 EUR
* Accordingly to number of visas requested. ** Accordingly to first night rate and number of rooms reserved and confirmed.

I, hereby, authorize Art-Hotel to charge my Credit Card accordingly to the details stated above.