Reservation Form
Pousada Tauma Hotel and Resort - Goa, India

For guaranteed reservations, transfer the deposit via the Swift-Code.
The fund transfer request and authorization needs
to be confirmed by fax or emailed to us to be valid.

Email Address :
Require Airport transfer? :	No Yes A/C car USD$32.00 Non A/C USD$19.00
Flight Details In :	Flight No      Time (local/dps)
Flight Details Out :	Flight No      Time (local/dps)
Suite Type :	Standard Superior Deluxe   <- Click hyperlink for preview.
How many suites :
Check in date :	(dd/mm/yy)
Check out date :	(dd/mm/yy)
How many adults ? :

Family name :
Given name :
Date of Birth :	(dd/mm/yy)
Nationality :
Passport No. :
Address :
City :
State :
Zip Code :
Country :
Phone :	Fax :
Special Request :

Payment Confirmation For Payment Confirmation, send your Credit card details by Fax on no.91 832 279064, as per the form given below. Please PRINT, fill-in the details and Fax it to us.

       

Type of Card:	-Choose One- MasterCard VisaCard
Issuing Bank	:
Credit Card Number	:
Expiry Date	:
Card Holder's Name	:
Card Holder's Signature	:
I hereby authorize Pousada Tauma to debit my Credit Card to the sum US$......................

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Please inform us, how you found our web site
Link from (name of site) :
Referrer Link :
Web Search Engine(s) :
A friend (email/internet address) :
Other (please specify) :