Pineapple Village On Line Reservation Form

Guest(s) Name(s)

Address 1    Address 2

City State Zip Country

How can we contact you.

Number of adults Number of children under 12 years of age

Arrival date (Month, Date, Year) Departure date (Month, Date, Year)

Number of nights Total number of rooms

Please enter below the number of rooms required:
Room(s) #  Garden Studio with kitchen
Room(s) #  Master Garden Bedroom-King Bed
Room(s) #  Master Garden Bedroom-King Bed
Room(s) #  Garden Bedroom-Two Double Beds
Room(s) #  Entire Villa

Method of Payment:  AMEX, Visa etc. 
                               
                               
**If mailing address is different then billing address, please include that address also below.**

Credit Card Number Expires (Month, Date, Year)

Name of cardholder (As it appears on card)   Security Code

Signature: Date:

*****Please print this form and fax to 800-874-1786 or scan and email to pineapplevillas@att.net******