Tara Lea Holiday House

 Reservation

First Name:

Surname:

Email Address:

Telephone Number:

Mobile Number:

Address:

Car Registration:

State:

Date of Arrival:

Date of Departure:

Number of Adults:

Number of Children:

Children's Ages:

Do you require linen hire? ($10.00 per person per stay) (Y/N)

Method of Payment: ( Cash, Cheque, EFTPOS, Credit Card)
Credit Card Type: ( Visa, Mastercard)
Card Number:

Card Expiry (MM/YY):

Cardholder's Name:
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