Beachcomber Motel

Reservation Form

Last Name
First Name
Email address (Required)

Street
City
State / Province
Country
Zip / Postal Code
Telephone (with Area Code / Regional Code)
Country Code (Telephone)
Number in Party
Children's Ages

Date of Arrival
Date of Departure
$- $ Rate Range Monthly Weekly Daily

Accommodation Preferences:

Beachfront
Waterview
Poolview
Other

Type of Room:

Efficiency Number of Rooms
Suite Number of Rooms

Bed Preference:

King Bed Queen Bed Double Bed Twin Bed

Other Requests:

Handicap Access

Special Requests

Reservation Guarantee

Exact Name on Card
Credit Card #
Expiration Date

(Did you remember to type in your e-mail address?)



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