Contact Information
Name:
Phone:
Email:
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Mobile Phone:

Contact Address
Street:
City:
State/Province:
Zip/Postal Code:

Requested Information
How many guests?	- Choose an Option - 1 2 3 4
Which room would you like?	- Choose an Option - #201 #202 #301 #303
Reservation Date (mm/dd/yy):
Is your Check In time AM or PM?	- Choose an Option - AM PM
Other Instructions: