403 Gulf Drive S.
Bradenton Beach, FL 34217
(941) 778-2431
Fax: (941) 792-3068
E-mail: usa2000@worldnet.att.net

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Bird's Nest On-Line
Reservation Request Form

25% Deposit is payable upon confirmation of booking
We will telephone you to acquire your preferred method of payment (VISA/MC)
The balance is payable upon arrival.

Please Fill & Complete All Fields
Note: Use "TAB" Key and/or Pointer to Move Between Fields

Arrival Date:     
Departure Date:   
First Name:   
Last Name:    
Address:      
City:         
State and/or Country:   
Zip or Postal Code:     

# of Adults:   
# of Children: 

Home Phone #:  
Work Phone #:  
Email Address: 
Today's Date:  


Additional Comments and/or Information: