Magnolia Ridge Hideaway
Reservation Request Form
(This is a Secure Reservation Page)

Please use this form to contact us or to make a reservation.
We confirm your reservation by email and mail you a Welcome Package.

Name:
Address:
City:
State:
Zip:
Telephone:
E-mail:
Is this a Gift Certificate?:
Please Choose Dates: Need to see a Calendar? - CLICK HERE
Arrival Date:
Departure Date:
I have read, understand &
agree to the Pricing Policies: 		(To Read Pricing Policies Page - CLICK HERE)
Reservation For: (Click any combination, or all for Private house Retreat)
Daisy Room (Sleeps 6):
Lilly Room (Sleeps 6):
Tulip Room (Sleeps 6):
Violet Room (Sleeps 6):
Private House Weekly Retreat:
Private House Mid-Week Retreat:
Just the Day Retreat: (Please include # of hours in the comments section)
Payment Information: (This form is secure and we never share
information with anyone for any reason.)
Credit Card Type:
Credit Card Number:
Expiration Date
Charge Me For Deposit Only:
Charge Me For Full Payment:
Questions or Comments:
(If you have a coupon code, enter it here)