FORM D

ISI2001 Hotel Accommodation Application Form

Please send this form by fax or e-mail to JTB Deadline: 20 June,2001

Japan Travel Bureau Inc. Yokohama Office
15F, Yokohama Nishiguchi KN Bldg.
2-8-4 Kitasaiwai, Nishi-ku, Yokohama 220-0004
, JAPAN

E-mail: danyoko9@mnm.jtb.co.jp

Fax: +81-45-316-5703

Title: Mr. / Ms. / Dr. / Prof.

Family name:                     Given name:                     Middle Initial:         

Organization:                                         

Mailing address:                                                                       

e-mail address                                            

Country:                      Telephone:                       Fax:                   

Arriving at                   on                             by                       .

              (airport)                 (date)                        (flight number)

Accompanying person’s name

Mr./Ms. Family name:                             Given name:                           

Hotel code (circle one):  1a      1b        2          3          4

Number of Twin Room(s):                    Number of Single Room(s):                   

Check-in:  July          ,2001  Check-out:  July            ,2001                nights

Hotel Deposit:            Room(s) ×20,000 JPY =              JPY

Payment: Total remittance                             JPY

 

Remittance

Credit Card

Please charge to my credit card specified below.

Type of card (circle one): VISA / MasterCard / Diners Club

Card Number   : _________________________________________

Expiry Date    : __________/__________ (month/year)

Card Holder's Name:                                                                               

 

Signature         : ___________________________________

Date: ________/_________/_________ (day/month/year)

Bank Transfer

Remittance has been made through                             (sender's name) to

The Bank of Tokyo Mitsubishi, Yokohama Branch

Account Number: 0043079 (ordinary account)

Account Name: Japan Travel Bureau, Inc.

Date of remittance                        ,2001.

Note

(1)   Personal checks are NOT accepted.

(2)   All payment must be in Japanese yen.

(3)   Please pay the bank commission charge and send a copy of your bank receipt confirming the payment to this form by fax.

 

Date:                                  Signature:                                

This application will become valid upon receipt confirmation from JTB.

 

 

Back to the 2nd circular of ISI2001