Wests Motor Inn Reservation Form

Wests Motor Inn Reservation Form
*Your Name or Agency Name : * Required** * if an Agency Booking - Travel Agency Name
Travel Consultant's Name : * If a Travel Agency Booking
Client's Name : * If a Travel Agency Booking
*Your Email Address: Required**
*Contact Phone Number: Required**
Fax Number :
Street Address, City, State and Post/Zip Code : * Required
*Country : Required**
Number of Adults:
Number of Children:
Children's Ages :
Date In :
Date Out:
Select Room Type:
Select Occupancy Type:
Smoking/Non Smoking Room:
Credit Card Number : (0000-0000-0000-0000)	* For Accommodation guarantee
Expiry Date: (mm/yr)
Cardholder's Name:
Comments, arrival details, etc :