Hôtel Moulin Vert

To reserve your room please fill out the following form which we will return with a confirmation:

First name:

Surname:

Address:

Zip code:

City:

Country:

Phone:

Fax:

E-mail:

Room type:

Payment (Secured reservation forms )
Master card CB VISA American Express Diner's Club	Card Number:
	Expiration Date:

Date of arrival (dd/mm/yy):
Number of nights :
Date of departure (dd/mm/yy)::

Comment: