APPLICATION FORM - SPANISH COURSES
 
*Surname *Name
Sex M F
*Adress
*City *Zip code *Country
*Nationality *Passport number
*Phone
Fax
*E-mail Date of birth / /
Ocupation Work number
Contact in case of EMERGENCY
Adress and phone number in Barcelona
 
COURSE SELECTED
Type of course
Hours/ day (Just private lessons)
Start date / /
Finish date / /
Number of weeks    
NOTE
SPANISH LEVEL Beginner Elementary Intermediate Advance Proficiency
HOW DID YOU HEAR ABOUT US?
Friend Internet Ex-student Travel agency Advertisement Others
 
ACCOMMODATION
FAMILY    
Type of room    
Start date / / Finish date / /
Do you smoke? Yes No
 
Do you mind a family smoke? Yes
No
Do you mind pets? Yes No
Is there anything else we need to nkow? (Diets, allergies, medical problems,...)
 
SHARED APARTMENT  
Type of room    
Start date / / Finish date / /  
Number of weeks        
 
STUDENT RESIDENCE (Only in summer)  
Type of room    
Start date / / Finish date / /  
Number of weeks        
NOTE
 
PICK UP SERVICE
ARRIVAL
Date / / Arrival time :
Flight number Airline Coming from
DEPARTURE
Date / / Departure time :  
 
PAYMENT
To confirm your booking you've to pay a deposit of 200€ deductable from the total cost. The rest must be paid at least two weeks before your arrival.
 
HOW TO PAY
CASH.
 
BANK TRANSFER.

Bank account details:
Pylmon Languages s.l.
Bank: La Caixa
Account nº: 2100 - 2878 - 66 - 0200714710
IBAN: ES77 2100 2878 6602 0071 4710
BIC code (SWIFT): CAIXESBBXXX
Address: Av.Diagonal, 431 bis - 08036 Barcelona
Please fax us a copy of the bank transfer whit your name. FAX (+34)933178192 (All bancks charges are paid by the sender)
CREDIT CARD , Only VISA or MASTERCARD (send by fax(+34)933178192 the authorization)

Information that must facilitate:
To title of the card - DNI/Pasaporte - Number of the Card (16 digits) - Date lapsing (mes/año) - authorized total Amount and authorized signature. Download document
* I agree with all the Pylmon Languages conditions
 
 
Pylmon Languages C/ Pau Clarís 89 Entlo. 2ª Barcelona (España) Tel. (+34)933013532 Fax.(+34)933178192