Secured Motorhome Reservation Request Form

All information provided is solely used for reservation purposes only. We do not submit any information
provided to third parties. Your request will be transmitted through a 128-bit secured server after
you press the send button.
REQUEST RESERVATION
  PERSONAL INFORMATION
   * Last Name:
   * First Name:
   * Email Address:
   * Reconfirm Email Address:
  ADDRESS INFORMATION
   * Phone:
     Fax:
   * Address:
   * City:
   * State:
   * Zip / Postal Code:
   * Country:
  RENTAL INFORMATION
Rental Destination
   Rental Station:
   I want to rent from:
   I like to return to:
My preferred rental dates are:
   Starting Date:    
   Return Date:    
   Total Rental Days:
Please select a Motorhome / Camper:
   1st Choice:
   2nd Choice:
Total travelers:
   Adults:
   Children:
Km / Mileage Plan:
   I prefer:
Insurance:
   Standard Insurance Included in Daily Rental Rates
   VIP Insurance (Optional)
Yes   $20.00 per Day
No
I require the following Extras: (additional charges)
   Please refer to our rate/information pages
   Convenience Kits:
   Camping Chairs:
   Toaster:
   Microwave:
   Mountain Bikes:
   Canoe Rental:
   Preparation Fee: Mandatory $65.00
   Bike Carrier: Mandatory with Bike Rental $60.00
Additional Comments & Requests:
Poll:
   How did you find us?
Are you interested to receive our destination newsletter?
Yes No
How do you rate our web site?
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 * I have read and understood your reservation policy.

  
            * = required