Reservation-Registration Please fill in and print this form. You may mail it to Cowie Wine Cellars or hit the "SEND" button to email it to us.
Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail address:
Date:
Date and Time of Arrival:
Date and Time of Departure:
Charges (Rate is $90 per night for the Cynthiana Suite or $125 per night for the Robert's Port Suite)
Other Charges:
Tax (7 %)
Total:
Since this is not a secure form, please do not send your credit card information if you press the "SEND" button. Please call with that information. We will be adding a secure form in the near future for your convenience.
Credit Card:
Visa MasterCard
Name (As appears on card):
Expiration Date:
Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Card Number:
Signature:
We agree that the Winery Bed and Breakfast is not responsible for accidents or loss of personal property. We agree to abide by the "Rules of the House" and we agree to pay the charges listed herein as well as any additional charges that may be incurred due to damage or loss according to the card issuer agreement with the credit card company listed above.
COPYRIGHT © COWIE WINE CELLARS 2006
