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RESERVATION
 
SECURE ORDER FORM
To process your reservation we will need ALL of the
following information...
Customer Name*
:
 
Enter only your first name, same as the first name that appears on your credit card.
Address*
:
 
The address that you enter MUST be the same as the one that appears on your credit card statements.
City* :
Country* :
State/Province* :
  Indicate state or province only if you live in the U.S. or Canada.
Zip/Postal Code* :
Phone Number* :
  Please include the area code of your telephone number
Fax Number* :
E-mail Address* :
   
Additional Information
     
Check In* :
Check Out* :
No. of Night* :
No. of Rooms* :
Room Type* : King Bed
    Double - Double Two Beds Room
    King Suite With Jaccuzi
    Double - Double Beds Suite With Jaccuzi
   
Special Comments* :
 
Secure logo
Credit Card Information and Authorization

Visa

Name on Card
Credit Card Issuing Bank or Issuer Name*
Card Number*
Card ID No *
(Which appears at the back of your card )  
Expiration Date*
I have read and agree to the cancellation policies.
"Press Submit Button Only Once"
  CANCELLATION POLICY
WEEKDAYS: SUNDAY THROUGH THURSDAY: 24 HOURS BEFORE CHECK IN DATE
WEEKENDS: FRIDAY & SATURDAY: 48 HOURS BEFORE CHECK IN DATE.
Regency Inn
4725, State Ave, Kansas City, Kansas 66102
Tel : 913-287-5511 Fax : 913-287-1021 E-mail : desaipaul@yahoo.com
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