Reservation Request
FULL NAME
*
First Name
Last Name
EMAIL
*
Confirmation Email
PHONE NUMBER
*
-
Area Code
Phone Number
ADDRESS
Street Address
Street Address 2
City
State / Province
Postal / Zip Code
COUNTRY
*
NUMBER OF ADULTS
*
1
2
3
4
5
6
CHILDREN (0-17)
*
0
1
2
3
4
5
6
CHILDREN'S AGES (COMMA SEPARATED)
CHECK IN
-
Month
-
Day
Year
Date
CHECK OUT
-
Month
-
Day
Year
Date
ROOM TYPE
Single Tent
Twin Tent
Double Tent
Honeymoon Tent
Family Tent
Bush Villa
ANY FURTHER COMMENTS OR INFORMATION
WHERE DID YOU HEAR ABOUT COTTARS?
HOW WOULD YOU LIKE US TO CONTACT YOU?
Call me directly
Email me
Send me the total cost of the Safari with Itinerary
Send me the Itinerary for my Safari (Applies to more than 3 day Safari)
Are you a repeat client?
Yes
No
SUBMIT FORM
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