Three Palms Resort Reservations Form

Welcome! Thank you for choosing Three Palms Resort.

Total Visits

Last Name:

First Name:

Address:

Zip:

City / State:

Country:

Email:

Phone:

Fax:

Visa Master Card American Express

Card Number:

Card Type:

Name on Card:

Expires:

Total Adults/Children:

Number of Beds:

Number in Party:

Rooms Needed:

Room Type:

Arrival Date/Time:

Departure Date:

No

Have you stayed with us before?

Yes

Comments:

If you do not wish to electronically submit this form, please print this form and fax it to: Three Palms Resort Fax: (954) 566-7748 or call in a reservation: (954) 566-7791 This can also be mailed to: 710 North Birch Road Ft. Lauderdale, Florida 33304