Name

Complete Address

Phone:

Fax:

Email

Arrival Date: JanFebMarAprMayJunJulAugSepOctNovDec 01020304050607080910111213141516171819202122232425262728293031 20052006200720082009    Arrival Time 123456789101112 000510152025303540455055 AMPM

Airline    Flight No.

Departure Date: JanFebMarAprMayJunJulAugSepOctNovDec 01020304050607080910111213141516171819202122232425262728293031 20052006200720082009 Time 123456789101112 000510152025303540455055 AMPM

Airline Flight No.

Total Adults    Total Children    Ages of Children

Select Room Type Please Choose One From This ListStudio w/1 Full/Double BedOne Bdrm w/1 Full & 1 Sofa bedOne Bdrm w/2 Twin & 1 Sofa bedTwo Bdrm w/2 twin 1 Full & 1 Sofa BedTwo Bdrm w/4 twin & 1 Sofa Bed

Credit Card Type Master CardVisaAmerican ExpressJCBDiners Club    Card Number

Expiration Date JanFebMarAprMayJunJulAugSepOctNovDec 200520062007200820092010

Will you need Transportation from Airport to Hotel? YesNo

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