4444 CITY AVENUE, PHILADELPHIA, PA 19131 (215) 878-3100
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Reservation Requests:
Please use this form to request reservations and additional information. Please provide as much detail as possible. Items marked with
*
are required.
Transactions are Secure.
All reservations will be confirmed via telephone.
Personal Information:
*
Name:
(First, Middle Initial, Last)
*
Street Address:
*
City:
*
State:
*
Zip:
*
Email:
(Please Select) (5 Digits)
*
Phone:
(
Day)
1
-
-
-
(Evening
)
1
-
-
-
The Best way to contact you is by:
Day Phone
Evening Phone
Email
Travel Information:
*
Expected Arrival:
January
February
March
April
May
June
July
August
September
October
November
December
01
02
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04
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31
2008
2009
2010
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2012
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2014
2015
2016
2017
2018
2019
2020
*
Expected Departure:
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
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14
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20
21
22
23
24
25
26
27
28
29
30
31
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Number of Adults:
Number of Children:
Desired Room(s):
Single
Double
Suite
Multiple Rooms
Payment Information:
*
Credit Card Type:
Visa
Mastercard
Discover
American Express
*
Name on Card:
(please type name exactly as it appears on card)
*
Credit Card #:
*
Exp: Date:
January
February
March
April
May
June
July
August
September
October
November
December
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
(please type number with no dashes or spaces)
*
CCV #:
(This 3 digit number should appear on the back of your credit card)
Billing Address:
(If different from the Contact Information above)
*
Street Address:
*
City:
*
State:
*
Zip:
*
Email:
Special Requests or Questions :
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