ONLINE RESERVATION FORM
Information you include on this form will remain confidential to Cornucopia Lodge.
This form will NOT be submitted via our secure server and could possibly be intercepted by unkown 3rd parties.
If you wish to ensure security of information you should use our SECURE Online Reservation Form.

Please complete ALL details, except where indicated as (optional)

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CONTACT DETAILS

First Name(s):

Surame(s):

Address:

Telephone: Fax: (Optional)
(Please remember to include your country and/or area code if outside Napier)

eMail:
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RESERVATIONS

Number of guests:    Number of rooms:

Date/Time of Arrival:

Date/Time of Departure:

We would like to have dinner on:
(Optional)

Special requests and/or comments:
(Optional)
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PAYMENT BY CREDIT CARD

If you wish to pay by NZ Cheque, please download the .doc or .txt form.

Credit Card:

Card Number:   Expiry: /
(Please enter your card number in the format: 1234-1234-1234-1234)

Name on card:

Amount paid as deposit: