Guest Information

Mr/Ms *

Given Name *

Surname *

Date of Birth * +

Mr/Ms

Given Name

Surname

Date of Birth +

Mr/Ms

Given Name

Surname

Date of Birth +

Mr/Ms

Given Name

Surname

Date of Birth +

If sharing a room with any other guests not listed above, please provide their names below:

Email Address *

Phone Number *

Travel Information

Departure Airport *

Arrival Airport *

Check In Date * +

Check Out Date * +

Room Category *

Payment Information and Credit Card Authorization

Billing Address *

Address Line 2

City *

Province/State *

Postal Code/Zip Code *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV *

Payment Amount *

Memo

This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. A written notice of rejection or cancellation of these arrangements must be received in writing within the time limits stated in the Terms & Conditions. If not received, no charge-backs or cancellation will then be accepted. Your signature on this charge confirmation form is an acknowledgement that you have received and read the Terms & Conditions and that you understand the Cancellation Policy, I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. I am aware that deposit payments are 100% non refundable and agree not to dispute or attempt to charge back any of the above signed for and acknowledged charges. * *

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