Corner Galo- Gatuslao Streets, Bacolod City, 6100 Negros Occidental, Philippines
Tel. No. (034) 434-961 to 63; Fax No. (034) 432-3537
                             Email Address: lacocohotel_shtm@gmail.com
                                      Exclusively used for Front Office subject only
ROOM RESERVATION FORM No. 0001
  Name (First): ________________________(MI): ____ (Surname): ______________________ Nationality: __________
  Salutation: Mr. _______ Ms. _______ Mrs. _______ others pls. specify: _____________ B-Day: ______________ Home
  Address 1: _________________________ Address 2: ___________________________ Zipcode: ____________ City:
  __________________________________________ Prov.: _______________ Country: _______________________
  Home Tel. #: ______________________________________ Work Tel. #:
  ______________________________________ Company:
  ______________________________________________________ Position: ___________________________
  MODE OF PAYMENT                                  BILL TO:                                 Date:
                                                   Personal                                 ________________
  Cash In House Charge                                                                      Arrival Time:
                                                  _______________________
  Credit Card                                     __ Company                                _____________________
  _____________________
  Card No. _____________________                  _______________________                    Departure Time:
  Card Expiry Date ______________                 __ Others                                  _____________________
                                                  _______________________                   LOS
                                                  __                                        _____________________
  ROOM NO. _________________                       I understand that my reservation is only for _________________
  Room Rate _________________ No.                  nights. Any extension is subject to room availability. The hotel is
  of Persons _________________                     not liable for money, valuables left in the room. I agree to pay all
                                                   charges incurred by me during my stay in the hotel. CHECK OUT
  DEPOSIT _________________ O.R. #                 TIME IS 12:00 NOON. Late check-out will incur a charge.
        _________________
                                                                  ______________________________
  Registered by:
                                                   Guest’s Signature
  _________________________________
  Suggested Preferences:
  _________________________________________________________________________________________________
  __
  _________________________________________________________________________________________________
  __
  _________________________________________________________________________________________________
  __
  _________________________________________________________________________________________________
  __
Remarks:
_________________________________________________________________________________________________
__
_________________________________________________________________________________________________
__
_________________________________________________________________________________________________
__