Address:

City: County/State:

Country: Zip/Postal Code:

Phone: Fax:

Email:

Dates Required: (Arrival) From: (Departure) To:

Persons In Party: Please list names (and age if under 16)

Option Required: Amount Due: 40% Deposit with booking:

Payment may be by cheque, cash or credit card.
This credit card information may be sent to an unsecured site and may be visible to others.
I authorise you to charge my account number below.

Method of Payment: Cheque Cash Visa MasterCard American Express

Name on Card:

Cardholder Address: Cardholders Registered Address (if different from above)

Credit Card #: Expiry Date:

Security Code:
(Visa/MasterCard: Last 3 digits on back of card)
(Amex: First 4 digits on top right on the front of card)

Please confirm the above booking.
Please note that all information is sent at your own risk.

Signed: Date: