403 East Shore Drive Clearwater Beach, FL 34630 727-443-6665
(If you are going to print this
form only
what you see will print).
Reservation Request Form
Please enter your Name:
Company:
Address 1:
Address 2:
City:
Including
Surrounding Region (U.S. Only)
Zip:
Country: United
States
Phone:
Fax:
E-Mail:
Type of Unit Desired:
Arrival Date:
Departure Date:
Number of Adults:
Number of Children:
Ages: Ages:
There are 4 ways to reserve your room with a 50% deposit. If the
room is not available on the dates you requested, your credit card will
not be charged.
You can fill out the credit card information required below and hit
the "submit" button.
You can fax this form with your credit card information.
You can call us with your credit card information
You can mail this form with your Check or credit card information.
Please enter type of Credit Card:
Discover VISA Master Card
Credit Card Number: Expiration:
Name on Credit Card:
Please enter any comments or special needs below,
To submit your information, press
Thank You.