|
:Mail or fax this form to Fax(207) 528 - 2479 |
Mt Chase Lodge 1517 Shin Pond Road, Mt Chase, ME 04765 |
Name_________________________________________________________________________
Address_______________________________________________________________________
City________________________ State_______________ Zip____________
Phone(day)___________________ Phone(evening)_____________________
Email Address__________________________________________________
Date of arrival______________________ Date of Departure____________________
Accommodations Requested check one, ( American plan main lodge,______ Housekeeping Cabins_______)
#Adults_______ #Children under 16______
Pets (additional charge)________________
Special requirements, dietary etc.____________________________________________________________
_____________________________________________________________________________________
Deposit enclosed, $___________________
Credit Card, Master Card_____ Visa_____
Discover_____
Credit card#__________________________ Expiration
date______________
Signature____________________________________
Home
| About Us | Contact Us
| Accomodations | Directions
| Hunting | Fishing | Photo
Gallery
Comments | Boy Scout Programs
| Snow Mobiling | Rates
| Links | Resources