FORM
Please fill out the form below.

     
 
surname
  
 
middle name
  
 
address
  
 
postal code
  
 
town
  
 
country
  
 
phone
  
 
fax
  
 
e-mail
  
 
special request
  
 
 
TARIFFS 2000-2001
Rates in FF
For 2 couples (4 adults)
FF 400/day or FF 10000/month
For 1 family (2 adults+2 children)
FF 350/day or FF 8000/month
 
ARRIVAL DATE
   
 
N° nights  
  
 
N° rooms  
  
 
N° of persons
  
 
Type of room
  
 

METHOD OF PAYMENT

 
 
1)
 At the reservation20% of the total coast by:  
 
Cheque Credit card
  
 
2)

Balance:

80% at the hotel after your arrival

 
 

If payment by cheque please send a cheque at the order of :

New Atlas Vacation.

To : P.O. Box 2195 Roseau - Dominica

As soon as we'll receive your cheque your reservation will be confirmed

 
 
 
 
SECURED PAYMENT BY CREDIT CARD
  
  Choose your credit card  
  Card number  
 
Date validity
  
 
N° rooms
  
 
From  
 
 
To  
 
 
N° Night
  
 
N° Persons
  
 
Total reservation
 
  I AUTHORIZE YOU TO DEBIT MY CREDIT CARD
FOR THE AMOUNT OF : 		 
 

CORRESPONDING TO  20% of the total of the reservation

THIS DEBIT WILL BE DONE AFTER OUR CONFIRMATION