112 Loch Street, Derby WA 6728 ยท Phone: (08) 9193 1044
| Date / Time: | Staff Member on Duty: |
| Guest Full Name: | |
| Mobile Phone: | Email Address: |
| Home / Postal Address: | |
| Vehicle Rego / Make & Model: | Number of Guests: [ ] Adults [ ] Children |
| Room Category: Deluxe Poolside Room ($235/n)
Standard Queen Ensuite ($185/n)
Twin Share Room ($195/n)
Kimberley Family Room ($265/n)
Contractor & Solo Ensuite ($145/n)
| Check-in Date: Check-out Date: Total Nights: [ ] nights | |
| Room Allocated: Room # [ ] Key Tag Number: [ ] | ||
| Nightly Rate: $ | Total Stay Amount: $ | Deposit Paid: $ |
| Payment Method Collected: Cash in Till Standalone EFTPOS (Receipt # ____________________) Card Imprint / Phone Auth Pay on Arrival | ||
| Balance Due upon Check-in/out: $ _________________ Paid in Full | ||
| Special Requests / Late Arrival / Housekeeping Notes: | |
| Guest Signature: X __________________________________________________ Date: ______________ | Staff Initial: [ ] Online Calendar Catch-up Ref: [ ] |