Reservation Request Form

This form is a request for availability only and not a confirmed booking.

You may also contact us directly by email at info@coxbaybeachresort.com or by phone at 250 725 2600.

Title	Mr. Mrs. Ms Mr. & Mrs. Dr.
First Name
Last Name
Address
Street
City
Province/State
Postal/Zip
Country
Phone
Email
Email Me About Future Specials	Yes No
Preferred Contact	Email Mail Phone
Arrival Date	dd-mm-yyyy or click
Departure Date	dd-mm-yyyy or click
Number Of Nights
Number Of Adults
Number Of Children
Pet ($40 fee)	Yes No
Select Room Type.	1 bedroom 2 bedroom
Have you stayed at Cox Bay Beach Resort before?	Yes No
Special Requests or Considerations
How did you hear about Cox Bay Beach Resort?	Newspaper Ad
	Billboard/Poster
	Friend
	Internet
	Other

Thank you for taking the time to fill out this reservation request.

The personal information that you have provided on this registration form will not be disclosed to any other party. The information provided on this web site is for general reference purposes only.