Siebert Realty - Virginia Beach VA - Rental Request

Reservation Request Form

Check-In Date:	03/03/2012
No.Nights	No.Adults No.Children
First	Last
Address

City
State	(Canada use QC,ON,NS at bottom of list)

Ocean Star
2952 Sandpiper Road

Zip
Day Phone
Cell Phone
E-Mail
Remarks
How did you find Siebert Realty?
Repeat guest Friend/Relative Postcard in Mail Email
Brochure in Mail Brochure from Virginia Welcome Station
Internet Search Engine (ie Google,MSN,etc..)
Internet Link (on another website)
Newspaper Ad in:
Other:

*Estimated Cost* Arrive:03/03/2012
Rental Charge for 7 Nights	:	920.00
Reservation Fee	:	60.00
Accidental Damage Protection	:	75.00
Sales Tax	:	52.75
City Tax	:	110.78
		----------
Total Charges	:	1218.53
Optional Travel Insurance
Travel Insurance	:	84.69
		----------
Total Charges w/Options	:	1303.22

E-Mail confirmation letter? No Yes

Enter security number:

Conditions of Reservation Request- Submission of this form constitutes a request for Siebert Realty to place a reservation in your name for the above mentioned property and check-in date. We are instructed by our owners to rent to Family Groups Only. Fraternal, sorority, student or single groups are asked not to apply for accommodations. The leaseholder must be at least 24 years old and understands that he/she must personally occupy the property for the entire period. We lease homes without respect to the race, color, religion, sex, national origin, handicap or familial status of any party. Your request submission acknowledges you are a qualified group. Siebert Realty does not guarantee availability of the property nor does submission of the form confirm a reservation. All reservation requests will be processed in the order in which they are received.

Thank you for placing a Reservation Request with Siebert Realty and we look forward to seeing you at beautiful Sandbridge Beach.

Siebert Realty - Established 1962 - 601 Sandbridge Road Virginia Beach, VA 23456
Toll Free (877)422-2200 - (757)426-6200 E-Mail: mail@siebert-realty.com