Eastern Townhouse - Reservations

To inquire about reserving a room, please fill in the following form and submit.
(Please note that credit card details are not secure on this web page)

Alternatively, fill in the following form, print out and fax to: + 61 3 9415 1502

Your Details
Name:	Address:
City:	Postcode:
State:	Country:
Phone:	Fax:
E-mail:	Preferred contact method:	Phone Fax E-mail Either

Accommodation
Arrival Date:	/ /
Departure Date:	/ /
Number of adults staying:
Number of children staying:
Accommodation:	Room type:
Comments

Payment
Payment Method:	Money Order Cheque Credit Card N/A
Card Type:	Visa Mastercard Bankcard American Express Dinercard N/A
Card Number: (not compulsory) Expiry Date: Signature: