<%@LANGUAGE="JAVASCRIPT" CODEPAGE="1252"%> <%@LANGUAGE="VBSCRIPT"%> <% fromName="your from name" fromAddress="your from address" toName="Lon White" toAddress="info@acaptainsquarters.com" subject="Website Reservation Form" relay="relay-hosting.secureserver.net" %> Untitled Document
A Captain's Quarters Banner

Registration Form

Personal Information

Full Name:

Company:

E-mail Address:

Mailing Address:

Phone Number:

How did you here
about us ?

 

Booking Information

Arrival:

Date: Time:

Departure:

Date: Time:

   

Rooms Needed:
(Check all that apply)

Captain's Suite at $159.00
Crew's 1 at $110.00
Crew's 2 at $110.00
or
Whole Facility

Number of Guests:
Beds Required:

 

 

Deposit Information

Reservations are guaranteed with 25% deposit or minimum of one night's rate. Deposits are refundable only if cancellation is made at least 30 days prior to scheduled arrival date. A processing fee of $25 will be charged for all cancellations.

   

Payment Method:

Deposit Amount:

Credit Card Number:

Name on Card:

Expiration Date:

Security Code:

(3 digit code on back of card)

 

Check your information, when finished, click submit, or print the form and fax or mail it to: A Captain's Quarters, Box 8845, Kodiak, AK. 99615. Fax number: (907) 486-6914.