Last Name First Name

Address City

Prov./State Country

Tel: Fax: Email

Date of Arrival # of Nights

# of Adults # of Children

PLACE AN "X" IN THE APPROPRIATE BOXES BELOW

Serviced Site 15 amp 30 amp

Unserviced Site

Tent Trailer 5th Wheel

Motorhome Car in Tow Length of RV in feet

VISA MASTERCARD

Card # Exp. Date