Form Bank Transfer

DETAILS OF PAYMENT
Name:
Surname:
Amount paid :
Name bank :
Product:
PERSONAL DETAILS
Name:
Surname:
Date of birth:	19
Address:
Post code:
City:
Country:
Home telephone:
Mobile:
E-mail:
Please insert the name of the other partecipants:




Important! I have read and accept London 4 London Ltd terms and conditions and I will advise all other partecipants as part of this reservation of these conditions.
Date: _____________ Signature: _____________________________

Please fax this document with the receipt of bank transfer to 0044 20 7015 9003