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Registration/Inquiry/Reservation Form

Please fill out the form below.  If you're just inquiring please do not fill out the Credit Billing Information.  Fill out the Qty/Description columns as follows: Qty = 1, Description: = VIP Room for 4 persons for 1 Night, 7/25/99

Please provide the following information:

QTY DESCRIPTION
BILLING
Credit card
Cardholder name
Card number
Expiration date
Your Home Address
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

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Last revised: July 28, 1999