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Reservation Form for offline submission

Rental Date: # Of Guests:
Name(s):   
  
  
  
Street Address:
City: State: Zip:
Home Phone Work Phone:
Payment Method: Check Credit Card
if check please enclose;
if credit card provide: card number: exp. date
Cleaning Option - Will you be cleaning up yourself? (Check One): YES NO
Rates: (in U.S. dollars)
Weekdays (Mon-Thurs): $100/night + 10% tax = $110.00
Weekends (Fri-Sun): $150/night + 10% tax = $165.00
1 Week or longer - Inquire for special rates
10% West Virginia tax applies to all rates and is included above
$100.00 refundable maintenance/cleaning deposit required
$50.00 nonrefundable pet fee w/any dogs
Rental 
Charges:
weekdays @ $110/night =
weekends @ $165/night =
Cleaning/Maintenance deposit (refundable) =
Pet cleaning fee (nonrefundable) =
Total =




Please print out and complete this form. You may either snailmail (with check) or fax (with credit card information) to the address/fax number shown below. If you have any questions, please email or call us.

Keep in mind that it will be easier (and totally secure) for you to register and provide your information online. Click here to do that instead.

I, being of sound mind and body, do hereby understand and agree to ALL conditions, arrangements, and prices stated above. I do also agree to pay for ALL and ANY property damage caused by myself and/or my guests. 1 will NOT hold the owner(s) of the home responsible for any negligent acts causing harm to myself or to my guests. I can and will ask any or all questions of concern prior to signing this rental agreement.

     Signature: X______________________     Date:_________
Co-Signature: X______________________     Date:_________
(If Applicable)

Questions? Email Us Please.
Phone: Lilian at (703) 998-0003 or (703) 868-3786
LBN Day Spa
3608 Forest Drive
Alexandria, Virginia 22302
Fax: (703) 578-1751

© 2003 all rights reserved ~~~ Berkeley Green Estate