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Please print this credit card authorization form (click the print icon above) and send to :
Fax: +30 22730 23205
Samos Hotel: Virginia Samos Hotel Rooms, Studios & Apartments - Family Hotel on Samos Island, Greece


Last Name : ___________________________________________
First Name : ___________________________________________
Check-In Date : ___________________________________________
Check-Out Date : ___________________________________________
Number of People : ___________________________________________
Number of Nights : ___________________________________________
Rooms: Qty./Type : ___________________________________________
Total Amount : ___________________________________________
 
Type of Card : ___________________________________________
Card Number : ___________________________________________
Issuing Bank : ___________________________________________
Expiration Date : ___________________________________________
Card Holder's Name : ___________________________________________
Telephone : ___________________________________________
Address : ___________________________________________

: ___________________________________________

: ____________________ Country _______________
 
Special Requests : ___________________________________________
: ___________________________________________
: ___________________________________________
: ___________________________________________
 

A deposit of 30% of your stay will be debited from your credit card at the time of booking, please see our terms and conditions to see our cancellation policy. By Submitting this form, you hereby agree to the Virginia Hotel terms and conditions.

Card Holder's signature :

Date: