Reservation Form (to be printed and mailed with payment)

Please print out this form, fill it out, and mail it back to the address at the end of this form.
Ed & Joanne Fussy 1-800-450-2094


Name  _______________________________________________________________

Address  ____________________________________________________________

City, State, Zip  ___________________________________________________

Phone _______________________________________________________________

Email _______________________________________________________________

1st Choice: Cabin ____ Dates: Arrival _______ Departure _______

2nd Choice: Cabin ____ Dates: Arrival _______ Departure _______

Number of:  Adults ________  Children ________
 

PLEASE RESERVE THE FOLLOWING IN ADVANCE 
   _____ 14' Fishing Boat   _____ 18' Deluxe Fishing Boat 

   _____ Electric Motor   _____ Fish Locator   _____ Lights 
 
   _____ Pontoon   ____ Dock space for your own boat   

   _____ Crib   _____ High Chair    _____ Twin Beds OR _____ King bed
Deposit Enclosed $ __________ Check # ___________________
   
     Credit Card # _________ / _________ / _________ / _________ 

     ____ VISA  ____ MASTERCARD  _______ / ______ Expiration Date

Signature ___________________________________________  
(Must be signed to confirm reservation) I understand I am responsible for my
full reservation and  have checked my arrival and departure dates.  I have read
and understand the cancellation and pet policy and that personal watercraft 
ATV's and fireworks are not allowed. I will be responsible for all damages.
Source of Referral __________________________________________________  

RETURN TO: PIMUSHE RESORT,7376 PIMUSHE TRAIL N.E.,BEMIDJI, MN 56601 

OFFICE USE ONLY: Confirmed By _________________ Date: _______________ 
 
Notes:_______________________________________________________________

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