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my contact options
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address:
18 The Esplanade
Perth
Western Australia 6000

telephone:
61-08-9325 2000

facsimile:
61-08-9221 2190

email: info@newesplanade.com.au

web: www.newesplanade.com.au

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my facilities
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rooms:
choice of standard and deluxe rooms (single, twin or double)

Please complete the Reservations Form.

PERSONAL DETAILS

TITLE	PROF DR MR MRS MS
NAME
COMPANY NAME
ADDRESS
TELEPHONE NUMBER
	County Code - Area Code - Number
FACSIMILE NUMBER
	County Code - Area Code - Number
EMAIL ADDRESS
	E.g.: info@newesplanade.com.au
BOOKING DETAILS
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 Day January February March April May June July August September October November December Month 2006 2007 2008 2009 2010 Year
ESTIMATED ARRIVAL TIME	example 10.00am
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 Day January February March April May June July August September October November December Month 2006 2007 2008 2009 2010 Year
NUMBER OF ROOMS	Single
	Twin or Double
	Triple
	Suite
SPECIAL REQUEST	Type in your special request here
PAYMENT DETAILS
NAME
CREDIT CARD TYPE	Visa Mastercard American Express Diners
CARD NUMBER
EXPIRY DATE	January February March April May June July August September October November December Month 2008 2009 2010 2011 2012" Year

THIS FORM IS SUBMITTED VIA EMAIL FORMAT.

Please note the compulsory fields. We will call and/or email you to confirm your reservations with us. Thank you and we look forward to seeing you soon.