Reservation Information Form

Please make your reservations by telephone first.

Toll Free 1-888-227-8573 or 1-912-638-3368
Fax 1-912-638-3409
Please print this form and complete all the information, sign and return this form
with your deposit within seven (7) days.

First Name :	Last Name :
Street Address :
City, State :, Zip Code :
Telephone :	e-Mail :
Cottage Selection :
Date of Arrival :	( After 4:00 p.m.)
Date of Departure :	( Before 10:00 a.m.)
Deposit Amount :
Payment by (circle one) : -----Check------------ Mastercard ------------Visa
Credit Card # : Exp. Date :
Make all checks payable to: Parker-Kaufman, Realtors and mail to Parker-Kaufman, Realtors, 1699 Frederica Road, St. Simons, GA 31522. In the event of cancellation, deposit cannot be refunded if the cottage is not re-rented. If the cottage is re-rented the Deposit less a $50 service charge will be refunded. Deposits may be placed in an interest bearing account by Parker-Kaufman and any earned interest retained by Parker-Kaufman to cover administrative expenses. If the payment is by credit card, the undersigned agrees to adhere to the polices of the card issuer.
Signature:__________________________________________
Additional Comments or Requests

Thank You for chosing Parker-Kaufman

1699 Frederica Road • St. Simons Island, GA 31522
Phone (912) 638-3368 • Toll Free (888) 227-8573 • Fax (912) 638-3409

Email