Winzerhaus Urbar
Rheingoldstr. 8

D-55430 Urbar / Loreley

Phone: from abroad 0049-6741 / 1366 or 0049-6741 / 93928

Fax: from abroad 0049-6741 / 7508

E-mail: info@loreleyvalley.com

I herewith ask for reservation of __________________________ incl. demi-pension and

(number of single/double bed/ triple bed rooms)

Program, €/Euro _______________________________ per person in the time

from __________ to ___________ .

(Day of arrival) - (Day of departure)

Sender:

First name, surname: ____________________________

Street/no.: _________________________________

Municipal code, place: ____________________

Telephone: _________________________

______________________________________

Date and signature