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)
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:

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Last Revised: August 27, 2007 09:00 PM