Credit Card Information
(For room confirmation only. No charges will be applied until check-out)
Online Reservations
Single (Queen bed)
Room Type *
Executive Suite
Room Rate*
Kitchen Required ? (weekly rental only)
Full kitchen
Half Kitchen
Smoking preference *
Non - smoking
Personal Information
Title *
First Name *
Last Name *
Phone (with area code first) *
Country *
Postal Code *
State or Province *
City *
Address 2
Address 1 *
Company Name
Comments / Requests
(up to 250 chrs please)
Email Address *
Arrival Date *
Card Type *
Card Number *
3 or 4 Digit Code  After Card # on back of Card *
Card Expiry *
Month *
Year *
Name (Exactly as it
appears on Card) *
Submission of your information is taking place over secured channels using industry-standard SSL (Secured Sockets Layer). No one except us can see your information. All details will be kept in our secure database just for the purposes of this reservation and will never be passed to third parties for any reason whatsoever.
Double (Two double beds)
Pets ? ($7.00/day extra)
Check-in time is 2:00 pm
Departure date *
Checkout time is 11:00 am
( * Required Fields)
This is a real life example. These forms have been built for Williams Inn Hotel ( As you see there are auto populated date fields, with data picker popups. The relevant script performs more than 45 different validations, for practically all fields. Many of the performed checkings are cross checkings, meaning that the script verifies values of a field depending on the values of another. The final result is that the info submitted is emailed to the hotel desk, an autoresponder message is sent to the customer, and the info is also stored in the database.  Please note that the template used here is only a screenshot of the actual template the client uses on his site.
Graphics and Logo created by Imageworks Creative Media Services for Williams Inn Hotel. Logo owned by Williams Inn Hotel. Form Layout, Thankyou and Error page Layouts, as well as processing script code created by
Please make a first submission, leaving all fields empty, to see how the script reacts to empty fields.

The validation script also checks for correct credit card number, among others. So, please use CC number  1234123412341238 or the script will not accept a non real CC number
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