(Please Fill Form Correctly)
Personal Information
February 5, 2012, 5:13 pm
Last Name:
*
First Name:
*
Complete Address :
Email Address:
Contact Number:
*
Reservation Information
Arrival Date:
-Select Month-
January
February
March
April
May
June
July
August
September
October
November
December
-Day-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-Year-
2009
2010
2011
2012
*
Departure Date:
-Select Month-
January
February
March
April
May
June
July
August
September
October
November
December
-Day-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-Year-
2009
2010
2011
2012
Arrival Time:
-Time-
1:00
1:05
1:10
1:15
1:20
1:25
1:30
1:35
1:40
1:45
1:50
1:55
2:00
2:10
2:15
2:20
2:25
2:30
2:35
2:40
2:45
2:50
2:55
3:00
3:05
3:10
3:15
3:20
3:25
3:30
3:35
3:40
3:45
3:50
3:55
4:00
4:10
4:15
4:20
4:25
4:30
4:35
4:40
4:45
4:50
4:55
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
- -
AM
PM
*
Means Of Transportation:
-Select Transportation-
Airplane
Ferries
Other (Please Specify)
(Others)
Number of Persons:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Room Type:
-Select Room type-
Deluxe Twin
Deluxe Queen
With Child/Children:
No
Yes
Extra Bed:
No
Yes
Airport /Pier Pick-up:
No
Yes
Remarks:
�2008 Kode Inn. All rights reserved.
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