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Wicker Country Lodge Reservation Sheet




Please complete the form below, send it to us using the "Send Form" button and we will confirm your reservation as soon as possible.


Arrival Date                    

Departure Date               

How many Rooms?         

No. of Persons, Adults    

No. of Persons, Children



Name:         

Address:     

Telephone:

E-mail:        

Cell phone:

Fax:             

Credit Card Holder          

Credit Card (Visa, etc.)   

Credit Card expiry date   


Where did you hear about us? (Friend, Advertisement etc.)    


Reason for stay? (Holiday, Wedding, Seminar etc.)   


Have you stayed with us before?   


If you do not hear from us within 24 hours please phone (0142) 77 1132

or

PAUL & DIANNE BLUMBERG, Cell: 082 443 7001


Thank you for booking.


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You'll love your stay
with us!


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