EXTREME POLYNESIAN BEACH HOUSE RESERVATION FORM
     
 
1ST STEP TO BOOK A RESERVATION

YOUR REQUEST FOR INFORMATION OR A BOOKING WILL BE ANSWERED WITHIN 24 HOURS BY EMAIL. TO SECURE A RESERVATION NOW, YOU MUST FILL OUT THIS FORM FIRST, THEN GO TO "2nd STEP TO BOOK A RESERVATION" AND MAKE A DEPOSIT WITH A CREDIT CARD. YOUR RESERVATION WILL BE HELD WITH A CREDIT CARD DEPOSIT - IF REQUESTED TIME IS AVAILABLE.

IF YOU NEED ADDITIONAL INFORMATION, JUST FILL OUT THIS FORM AND EMAIL US. YOU QUESTIONS WILL BE ANSWERED WITHIN 24 HOURS. IF YOU WANT TO MAKE A PAYMENT BY CHECK TO SECURE YOUR RESERVATION, YOU MAY ALSO USE THE "MAIL IN FORM" AT THE TOP OF ALL PAGES, BUT STILL FILL OUT THE FORM BELOW.

ONCE DEPOSIT MONIES ARE RECEIVED, YOU WILL RECEIVE A CONFIRMATION NUMBER FOR YOUR CONFIRMED RESERVATION. FULL BALANCE IS DUE 60 DAYS PRIOR TO ARRIVAL DATE.

(You may also use this form to place your name on a "CANCELLATION WAITING LIST". We will notify you if your requested time becomes available.)

Instructions

Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send us your request.



Your Name: *
Company Name : *
Address: *
City: *
State or Providence: *
Country: *
Zip: *
Phone and Cell Phone number
There is no phone service on the island. Please give us a cell number in case we need to contact you during your stay.:
*
Fax:
E-mail address: *
Comments:
1ST-DESIRED DATE OF ARRIVAL AND CHECKOUT:*
2ND-DESIRED DATE OF ARRIVAL AND CHECKOUT:*
Comments or Request for Special services such as crib, additional beds, daily maid service, or other special needs. Check in time: 4:00 pm
Check out time: 10:00 am:

NUMBER OF ADULTS OVER 21 IN PARTY :*
NUMBER OF CHILDREN : *
AGES OF ALL CHILDREN: *
NUMBER AND BREED OF PETS: *
Last names of other Adults to be listed on the contract.:



(Fields marked with * are required)




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