EmailMe Form - Pippert/Jackson Wedding

Pippert/Jackson Wedding

Room Reservation Form
Wedding Date: April 28, 2021

All Inclusive Weddings
Elizabeth Schemper
beth@allinclusiveweddingplanner.com
785-543-4676

Please fill out the following information to secure your room for your trip.
If, for some reason, the room you request is unavailable, I will get in contact with you.

Thank you!

The block of rooms are saved from April 26th - May 3rd. If you need make your reservations outside of those dates, you will need to contact Beth. Prices outside of the contract are not guaranteed.

Day of Arrival *
MM / DD / YYYY
Day of Departure *
MM / DD / YYYY
Please choose your room category. *
Partial Ocean View
Ocean View
Ocean Front (only available with two queens)
Bedding Request *
King Bed
2 beds
Personal Information
One Form Per Room

--------Guest 1--------

Full Name *
First Middle Last
Please enter your name EXACTLY as it appears on your passport. For those that do not have a passport yet, please enter your full name.
Date of Birth *
MM / DD / YYYY
Gender *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email *
--------Guest 2--------

Full Name
First Middle Last
Please enter your name EXACTLY as it appears on your passport. For those that do not have a passport yet, please enter your full name.
Date of Birth
MM / DD / YYYY
Gender
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
### - ### - ####
Email
--------Guest 3--------

Full Name
First Middle Last
Please enter your name EXACTLY as it appears on your passport. For those that do not have a passport yet, please enter your full name.
Date of Birth
MM / DD / YYYY
Gender
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
### - ### - ####
Email
--------Guest 4--------

Full Name
First Middle Last
Please enter your name EXACTLY as it appears on your passport. For those that do not have a passport yet, please enter your full name.
Date of Birth
MM / DD / YYYY
Gender
--------Deposit--------

A deposit of $100 per person is required to reserve your room. Please fill out the following information to be able to put your payment towards your room.

* You are allowed to deposit more if you desire. *
$ Dollars . Cents
Name as it appears on Credit Card *
Card Type *
Visa
MasterCard
American Express
Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
E-Signature
By signing below, I ensure all of the above information is correct. By signing below, I also authorize Elizabeth Schemper d/b/a All Inclusive Weddings to apply payment, on my behalf, using the credit card information indicated in this authorization form. This payment authorization is for the amount indicated above and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company so long as the transaction corresponds to the terms indicated in this form.
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