**PLEASE FAX THIS FORM DIRECTLY TO THE HOTEL 617-424-8798**

OR email to info@jewelboston.com

HOTEL RESERVATION FORM

Name_______________________________________________________________________

Address ____________________________________________________________________

City _____________________________ State ________ Zip _______

Country____________

Phone (Home) ________/__________________ (Office) _______/______________________

(Fax)_______________________ e-mail address ____________________________________

ARRIVAL	DEPARTURE
Date / Time / Airlines /Flight #	Date / Time / Airlines /Flight #

• All rates subject to state room tax

Sharing room with ___________________________________________________________

Name of individual (If children, please list names & ages)

Special Requests (not guaranteed): ___One King OR ____2 Double Beds ___Smoking OR ___ Non-smoking

GUEST NAME: (Please print) _____________________________________

PAYMENT METHOD

By Personal Check or By Company Check Check # _______

By Credit Card --

Type: Visa MasterCard American Express Discover
Diner's Other card __________________

Card Number: ___/___/___/___ ___/___/___/___ ___/___/___/___ ___/___/___/___

Exp: Date ____ ____ / 20 ___ ___

(Month Year)

Cardholder’s Name: ____________________________________(Please Print)

Signature____________________________________________________

Date_____________________