Please provide the following contact information:

Name
Street Address
City
State
Zip/Postal Code
Country
Work Phone
FAX
E-mail

                            Enquiry/Special Requirements

( Leave the below fields empty, if you are using this form to make a general enquiry )

Payment Details:

Credit card details are required to secure a booking but will not be processed
until the date of your arrival.

If you should cancel your stay within 24 hours prior to arrival, your card will be charged the full amount
of your first nights accommodation. Full payment is due upon departure.

By providing your credit card details, you are hereby agreeing to the above conditions.

Credit Card Type	Please select Mastercard Visa
Name  on Card
Card Number
Expiry	01 02 03 04 05 06 07 08 09 10 11 12  /	15 16 17 18 19 20 21 22