RESERVATION FORM

Are you ready to reserve a trip?
To place an order please copy this text in a word document and fill in the details below. Print the form and fax it to us at the fax number at the bottom of this page. We will process your request immediately and inform you of the status of your order by email or fax.

Full Name:............................................................................................................
Address:.........................................................................................................
City: ....................................... State: ............................... Zip: .................
Country: ..........................................................................
Daytime phone: ..............................................................
Evening phone: ...............................................................
Fax: ................................................................................
Email: .............................................................................
Passport number: ...........................................................
Nationality: ....................................................................
Trip Days: ................................
Lunch and Dinner: Veg...........................................Non Veg.......................................
Starting Date: Month: ................ Day: ............. Year: .......
Land Cost per person: U$S........................... Number of Persons...............
You can pay with Cash or Bank deposit

Bank Deposit: To Rafael Lamas Citibank Mendoza N°521 804 4818.
CBU:016 7777 1000 5218 0448 185
Total amount of deposit: U$S ....................................

I have read and understand the accompanying statements regarding responsibilities and liabilities, cancellations and refunds, as well as the included features for this program.

Date:...................................... Signature............................

Casa Central: Padre Arce 55, Godoy Cruz (5501) - Mendoza - Argentina.
Email: info@ecopuesto.com.ar - Phone/Fax: (0054-261) 4222788 Mov:155-086-134