Your Name: 

Phone Number:  

Address: 

City & State:   

Zip Code: 

Type of Vehicle ( Trailer, Motor Home, Etc.) 

Length of Vehicle: 

Number of Slide Outs:     Space Category:  Pull Thrus Back Ins

Do You Require 50 Amp Service ?  Yes   No 

Cable TV ?  Yes No

Number of Days of Planned Stay: 

Arrival Date:                      Check out Date: 

Number of Persons Staying:      Number of Adults in your Party: 

Good Sam Number: 

Reservation With:  MasterCard  Visa  Check

Card or Check Number: Expiration Date:

E-Mail Address: 

Comments: