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Reservation Request Form |
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| Name: __________________________ | Company: _________________________ | ||||||||||||||||||||
| Address: __________________________ | Phone #: __________________________ | ||||||||||||||||||||
| FAX #: ___________________________ | E-mail : _____________________ ______ | ||||||||||||||||||||
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Please fill out the following for your requested dates: |
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Method
of payment accepted: Checks: company, personal, cashiers, money order |
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Please make all checks payable to: |
3639 LLC
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| and forward to: | Lisa
Economos 3050 Pheasant Creek Drive #209 Northbrook, IL 60062 |
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| ________________________________ Signature |
__________________ Today’s Date |
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| Amount of Deposit
$_____________
Please fax this form directly to (847) 291-9447 and be sure to send a copy along with your payment. |
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