Your Name* (on charge card)
 E-mail Address*
 Business Name
 Billing Address* (on charge card)
City*     State/Province*
 Country              ZIP/Postal Code*
Day Area Code*     Day Number*
Alt. Area Code         Alternate Number

Charge Card Type:*
VISA     MasterCard     Discover     AMEX    

Charge Card Number*

Expiration Date* (mm/yyyy)

 Arrival (mm/dd/yyyy)*
 Departure (mm/dd/yyyy)*
 Number of Guests*

Accommodations Requested:
The Island Guesthouse
Wright Get A Way
Endless Summer Cottage
Little Lifeboat House
Bahamas Cottage (available Winter 2007)

Do you have a dog that will be accompanying you?
 Yes      No

How do you hear about The Island Guesthouse and Cottages?
Magazine/Newspaper
Chamber of Commerce or Tourist Bureau
Search Engine
Link from another site
Referral
Other

Please let us know of any special needs or interests you may have: