[Grassy Head Hideaway]

Reservation & Information
Request Form

If you are interested in making a reservation, filling out and submitting this form does not complete the reservation. We will process your enquiry then contact you by phone or e-mail. We will let you know of availability and how to make payment to secure your holiday.

Day Of Month Month of year

Number of Nights:

Number of People

Your Title : Your Surname :
Your Christian Name (s):
Your Street Number & Name:
Town or Suburb: Post Code (Zip):
Home Phone : Fax Number :
Email address :

Please tell us how you found out about our site:

If you read about Grassy Head Hideaway in a magazine, which magazine was it? :

Do you have any special reason for staying at Grassy Head Hideaway?

Do you have any comments, questions or special requests at this time
( Press Enter/Return at the end of each line)

Would you like cost confirmation?.YesNo
Would you like a brochure on Grassy Head Hideaway?.YesNo
Would you like information on local activities?.YesNo

Would you like to make a firm booking (subject to confirmation by us)?.YesNo
If yes, we will be in contact.

Click here to NOT SEND THIS FORM
and return to Grassy Head Hideaway Home Page