Secure Reservation Form

Secure Reservation Form
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Reservation Form

Name:
Number in Party:
Type:
Arrival Date: (Example: 8/2/06 or 08/02/06)
Departure Date: (Example: 8/2/06 or 08/02/06,
If departure date is Unknown, enter ??????, six question marks)
Are you a Good Sam Member? Select an option below . . .
     Yes, I am a Good Sam Member, place your ID number in the box below for the Good Sam Discount
     No, I am Not a Good Sam Member
Good Sam ID: Your Good Sam Member ID for Good Sam Discounts:
Vehicle Information, (Car, Truck, Camper or RV)
Your Vehicle's tag #: , (License Number of the Primary Vehicle), Required
Issuing State; , (State or Province where vehicle is licensed), Required
Drivers license #: (Your Drivers License Number), Required
Issuing State: , (In what state was your license issued), Required
How did You hear out Us? , Required
    Please specify if you selected "Other"
Comments:

RV Info:
RV License Tag #;, (the license number of the RV, Trailer, Pop-up)
Length; , (in feet, round up to the whole foot)
Amps; , (required by your camper)

Contact Info
Name: , (Required to verify this reservation)
Email: , (Phone or Email is Required to verify this reservation)
Phone: , (Phone or Email is Required to verify this reservation)
Cell Phone: , (so we can reach you on the road if you are late.)
    NOTE: (If Neither Phone or Email is provided, we have No Way To Verify this Reservation,
Therefore, We Can Not Accept or Honor requests without a contact email or phone.)

Payment Info
Card Type:
Number: ---
Verification Code: , (3 digit code located on the back of your card,
    normally found at end of the printed card number just above the magnetic strip.)
Expiration: Month , Year

Name: , (as it appears on Card)
Billing Address: , (Address used by the issuer of this card)
Billing City: ,
State/Province,
Postal Code:
Country:

Please only click the "I'm Done - Submit Request" button once - allow enough time, (one to three minutes), for our server to verify the connection and the information you have provided, before it moves on to the next page.
It may appear to be stuck but it can take as long as as a couple of minutes before going on to the receipt page.

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Last Revised: May 31, 2010 10:47 AM