Hotel Name:

_________________________________________or Choose A Hotel For Me:  Yes  /  No

Title:

First Name:

Last Name:

Home Ph:

Work Ph:

Email:

Fax:

Country:

   Month        Day      Year

Arrival Date:

Arrival Time:

Depart Date:

Please be aware of date and time changes when crossing the international date line. We suggest you check your ticket to avoid problems on arrival.

Number of Occupants:

Number of Beds required:

Special Requests: (eg
price range)

__________________________________________________________

Payment details are required ONLY if you wish to book (and hold) the room. Otherwise leave blank.

Credit card:

Card Number:

Name on Card

Expiry date:

Please reply/confirm by email.

  (my email address is above)

Yes  /  No

Please reply/confirm by fax.

  (my fax number is above)

Yes  /  No

I accept a 10%, non-refundable deposit will be charged to the above card at the time of booking. (This charge will appear as M-Power on my credit card statement). The remaining 90% of my booked stay will be paid to the hotel (as per the hotel payment policy). Please note: the hotel may impose a cancellation fee if the booking is cancelled after this booking is made. Please check your hotel's policies.            Yes  /  No

Signature of card holder  __________________________________________

PS: How did you find us
       on the web?

 (e.g. Which Search Engine / Directory or other means did you use to find us?)