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 Polly's Motel  

Please complete the following form to make a preliminary reservation.  We will contact you to finalise your booking.

Please allow up to 48 hours for us to respond to your reservation request.

Reservation Type

Leisure

Corporate

____________ Arrival and Departure Dates ____________
 

Arrival Date

Approx. Time

a.m

p.m

Departure Date

Number of nights

Number of adults

Number of children

___________________ Preferences ___________________

Number of Rooms

Desired Room

1 Bedroom (Motel Unit) Only

_______________ Comments/Requests _______________

Please note any additional comments or requests

Contact Information

*Your Name:

*Home Phone:
(include Area Code)

*Business Phone:
(include Area Code)

(Day time hours)

Fax:

Email:

*required information

Please phone after 48 hours if your booking has not been acknowledged or confirmed.

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