BEAR'S BUNGALOW RESERVATION INFORMATION
(offered by K. C. Rentals)
Mailing address: P. O. Box 3506, N. Ft. Myers, FL 33918-3506
Request for reservation for Bear’s Bungalow:
Today’s Date:____________________
Requested arrival date:________________________________
Requested departure date:_____________________________
Name:_____________________________________________
Address:___________________________________________
City/State/Zip:______________________________________
Home phone: _______________ Cell phone: _____________
Other phone: _______________ Fax number: _____________
Email address: _________________________________
How many in party?: Adults _____ Children _____ (3-12)
If making reservation, which credit card will you be using:
M/C or VISA or DISCOVER
please circle one
Card number: ______________________________
Expiration date: ____________________ CVS code: _______
Name card issued in:_________________________________
Card Billing Address:_________________________________
City/State/Zip:______________________________________
By my signature below, I hereby give K. C. Rental / Kelly Tuttle
permission charge my credit card above for deposit due or full
balance as outlined in Rental Agreement.
Authorized signature: ______________________________
Printed name: ____________________________________
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***PLEASE PRINT FORM AND COMPLETE. BE SURE TO SIGN IT BEFORE YOU RETURN IT TO K. C. RENTALS LLC BY EMAIL, FAX OR POSTAL MAIL***
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