Reservation Request Form Your Name Address City, State Zip Email Phone Date of Arrival Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: January February March April May June July August September October November December Year: 2011 2012 2013 2014 Number of Nights Select One 1 2 3 4 5 6 7 8 9 10 More than 10 Number of Guests Select One 1 2 3 4 5 More than 5 Room Preference Select One Non-Smoking 1 Queen Room Non-Smoking 2 Queen Room Non-Smoking 1 King Room Credit Card Type Select One VISA MASTER AMEX DISCOVER Credit Card Number Expiration Date Month: January February March April May June July August September October November December Year: 2011 2012 2013 2014 Questions/Comments:

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