FLAGSHIP INN - BREMERTON, WA RESERVATION BY FAX REQUEST FORM Instructions: 1) Print this form 2) Type or Print to complete the form Be sure to include your credit card details 3) FAX it to: (360) 479-6745 4) We will verify room availability as requested and call or Fax you with confirmation. Full Name:_____________________________________________________________ Company (If Corporate Rate):___________________________________________ Address:_______________________________________________________________ City:____________________ State/Prov:______ Post/Zip Code:___________ Country:_________________ Home Phone Number:__________________________________ Work Phone Number:__________________________________ FAX Number:__________________________________ eMail Address:__________________________________ How did you locate our Web Site:____________________ ********************** Credit Card Information ************************ Type:______ Number:______________________________________ Exp:________ Full Name as it appears on Card:_______________________________________ *********************************************************************** Check In Date:____________________ Check Out Date:____________________ How Many Rooms:______ How Many Adults:______ How Many Children:______ Room Configuration: [ ] King Sized Bed [ ] Two Queen Sized Beds Preference: [ ] Smoking [ ] Non-Smoking Rate Requested: [ ] Standard [ ] AAA/CAA [ ] Senior/AARP [ ] NCOA [ ] Federal Per Diem [ ] WA State Per Diem [ ] Corporate [ ] Kitsap Card Comments: