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Corner Galo- Gatuslao Streets, Bacolod City, 6100 Negros Occidental, Philippines

Tel. No. (034) 434-961 to 63; Fax No. (034) 432-3537


Email Address: lacocohotel_shtm@gmail.com
Exclusively used for Front Office subject only

ROOM RESERVATION FORM No. 0001


Name (First): ________________________(MI): ____ (Surname): ______________________ Nationality: __________

Salutation: Mr. _______ Ms. _______ Mrs. _______ others pls. specify: _____________ B-Day: ______________ Home

Address 1: _________________________ Address 2: ___________________________ Zipcode: ____________ City:

__________________________________________ Prov.: _______________ Country: _______________________

Home Tel. #: ______________________________________ Work Tel. #:

______________________________________ Company:

______________________________________________________ Position: ___________________________

MODE OF PAYMENT BILL TO: Date:


Personal ________________
Cash In House Charge Arrival Time:
_______________________
Credit Card __ Company _____________________
_____________________
Card No. _____________________ _______________________ Departure Time:
Card Expiry Date ______________ __ Others _____________________

_______________________ LOS
__ _____________________

ROOM NO. _________________ I understand that my reservation is only for _________________


Room Rate _________________ No. nights. Any extension is subject to room availability. The hotel is
of Persons _________________ not liable for money, valuables left in the room. I agree to pay all
charges incurred by me during my stay in the hotel. CHECK OUT
DEPOSIT _________________ O.R. # TIME IS 12:00 NOON. Late check-out will incur a charge.
_________________
______________________________
Registered by:
Guest’s Signature
_________________________________

Suggested Preferences:

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Remarks:

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