I am interested in a stay in the Pension Theresianna

Duration of stay:

from _____________    until _____________
 

Number of persons

___Adults               ___ Children
 

Typ of room

O    Single                O    Double
 

Sender

Name, Prename	___________________________________________
Street	___________________________________________
Zip Code, Town	___________________________________________
Country	___________________________________________
Phone	___________________________________________
Fax	___________________________________________
E-Mail	___________________________________________

Date: _________ Sign: ______________________________