Reservation Request Form

To request a reservation via email,

you may copy and paste the following information into a new message and send it to ledock@cox.net

(Right-click "select all", then right-click "copy", then in your new email text section right click "paste". )

OR, print out and return this completed RESERVATION REQUEST FORM by fax to 337.233.6682

Upon confirmation of Room A availability, deposit payment (*check / Money Order*) can be mailed to:

Le Dock, c/o 312 Suffolk Avenue, Lafayette, LA 70508

Name

Address

City

State Zip

Phone Fax

e-mail

Do you need boat parking?Total # of guests

Arrival date Departure date

I understand the 72-hour advance rental/cancellation policy for Le Dock sur le Bayou in order to receive full refund of deposit.

Guest Signature

*Print & Return this completed form by fax to 337.233.6682 or mail to: LeDock /312 Suffolk Avenue, Lafayette, LA 70508

email: ledock@cox.net

Phone: 225.266.0799