Madeira Island Hotel and Residential Accommodation Info - Residencial Americana

Please note that fields indicated with a red asterisk like this one mean that the corresponding field is a "required field" to be filled in. That is, the form cannot be submitted without some required information to be included in the form as will be found below.



Dates of Reservation:

Start Date:
End Date:
Year:	1998 1999 2000



Rooms (Prices per room)

Rooms redecorated - all with private facilities (shower), refrigerator, water boiler, safe and direct dial digital telephone.
	Please type in how many rooms you need of each
Double or Twin -12 Rooms available	7.500$00 - Bed and Breakfast Included
How many people would this amount to ?
If necessary can we contact you to place a deposit on your accommodation ?	Yes No



Travel Information (if available):

	Flying in Not Flying in
Airline Name:
Flight # :



Personal Information:

Your Name:
Your e-mail Address:
Your Address:
Your telephone number:
Your Fax Number ( if available):
Is it possible to tell us your Nationality or Language ?
If this accommodation is already taken can we notify you of alternative accommodation ?	Please tick if yes



How did you find us ?

	Other



Any questions or special requests ?
Please edit any query you might have in this box: