If you wish to make your reservation request by fax, please fill in the following form and fax it to Benotel at +32-2-768.17.68.

YOUR INFORMATION :


Your Name       :  ...............................................

Address         :  ...............................................

                   ...............................................

Telephone       :  ..................   Fax  :  ..................

Email           :  ...............................................



RESERVATION INFORMATION :


Hotel Name      :  ...............................................

City            :  ...............................................

Arrival Date    :  ...........   Departure Date  :  ..............

Number of Rooms :  ...........

Room Type 	:  ....................  (single, double,..)

Remarks         :  ...............................................

                   ...............................................

                   ...............................................


Credit Card     :  .....................  Owner  : ...............

Card Number     :  .....................  Expire : ...............

Signature       :  ...............................................