<!--includeForm-->


<form method="post">


<h3>Заявка</h3>



 
		<b>Ваше Имя:</b><SPAN style="color:red">*</SPAN><br />	<input type="text" size="30" maxlength="150" value="" name="d[0]" id="d[0]" />
		<br /><br />




 
		<b>Телефон:</b><SPAN style="color:red">*</SPAN><br />	<input type="text" size="30" maxlength="100" value="" name="d[1]" id="d[1]" />
		<br /><br />




 
		<b>Email:</b><br />	<input type="text" size="30" maxlength="100" value="" name="d[2]" id="d[2]" />
		<br /><br />




 
		<b>Дата и время заезда:</b><SPAN style="color:red">*</SPAN><br />	<input type="text" size="30" maxlength="100" value="" name="d[3]" id="d[3]" />
		<br /><br />




 
		<b>Дата и время выезда:</b><SPAN style="color:red">*</SPAN><br />	<input type="text" size="30" maxlength="100" value="" name="d[4]" id="d[4]" />
		<br /><br />




 
		<b>Количество гостей:</b><SPAN style="color:red">*</SPAN><br />	<input type="text" size="30" maxlength="100" value="" name="d[5]" id="d[5]" />
		<br /><br />




 
<b>Дополнительно:</b><br /><TEXTAREA cols="50" rows="7" name="d[6]" id="d[6]"></TEXTAREA>
<br /><br />



 
	<input type="hidden" value="" name="d[7]" id="d[7]" />




 
	<input type="hidden" value="" name="d[8]" id="d[8]" />




 
<INPUT type="checkbox"  name="d[9]" />Согласие на обработку <a href="/dogovor-oferta">персональных данных</a>
<br /><br />



 

<br clear="all"><br>

<input type="submit" value="Отправить"><re-captcha data-captcha="recaptcha"
     data-name="captcha"
     data-sitekey="6LcNwrMcAAAAAOCVMf8ZlES6oZipbnEgI-K9C8ld"
     data-lang="ru"
     data-rsize="invisible"
     data-type="image"
     data-theme="light"></re-captcha></form>





<script src="/shared/misc/calendar.gen.js" type="text/javascript" language="javascript" charset="utf-8"></script>
<!--includeForm-->
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