If you want to spent your holiday on our wine farm, please fill in this application form. Fields marked with a star (*) are compulsary.

name*
street, no.*
town*
phone number*
fax number
e-mail-address

Please send me/us a brochure of the holiday appartment. yes no

I want to book the holiday appartment for.

children among:
arrival date . .
departure date . .
notes:

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used form mailer: Nether-Mail.