Mr Mrs Ms

First Name

Last Name

Address

Postal Code

City

Country

Phone

Fax

E-Mail

Special Request

Arrival Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   january february march april may june july august september october november december 2008 2009 2010

Departure Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   january february march april may june july august september october november december 2008 2009 2010

N° nights 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  

N° rooms 1 2 3 4 5 6 7 8 9 10  

N° of persons 1 2 3 4 5 6 7

Type of room Choose your room Single Standard Single Superior Double Standard Double Superior Triple Standard Triple superior Quadruple Superior

Method of payment

At the reservation 20% of the total cost:

by Cash or Credit Card

At the reservation 80% of the total cost:

by Cash or Credit Card

If payment (20%), is done by Cash please send it at the order of : JOSHUA ROSE GUEST HOUSE, Back Street Philipsburg - Sint Maarten. As soon as we receive your cheque your reservation will be confirmed.

Payment by Credit Card

Choose your credit card Choose your Credit Card American Express Diners Club Master Card Visa Card

Card Number

Date validity

Total reservation

I AUTHORIZE YOU TO DEBIT MY CREDIT CARD
FOR THE AMOUNT OF :

CORRESPONDING TO 20% of the total of the reservation
THIS DEBIT WILL BE DONE AFTER OUR CONFIRMATION