Booking Form Phone Reservations on
(03) 5560 5265
Arrival:
(dd)
*
(mm)
*
(yyyy)
*
Departure:
(dd)
*
(mm)
*
(yyyy)
*
Number of people:
*
Adults
*
Children
Unit / House Type:
Flagstaff:
Hopkins:
Merri:
Moyne:
Title:
Mr / Mrs / Ms / Mr & Mrs / Family / Other:
Guest name
last and (first name or initial)
*
Address details:
Street:
City:
State:
Postcode:
Your e-mail address
*
:
Phone
*
:
Fax:
Preferred Method of Contact:
Email
Phone
Mail
Fax
Special instructions:
Securty Code
*
This is a preliminary booking only. All bookings will be confirmed by phone.
Required Fields
*
We will send you a booking confirmation. If you do not receive an acknowledgement of your booking request, please check your email details and then contact us again.
Privacy Policy
We know you are concerned about your privacy. If you provide us with information about yourself or your business, such as name, postal/e-mail address or other data, this information may be added to our internal data records. All information received from you (either by mail/fax or in any electronic format), however, is used internally, by
CountryLife
staff members only. No details will be supplied to a third party, unless required by law/statutory obligation or with your express prior approval.
CountryLife
will not sell your personal information to any outside interests.
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