Jackpine Lodge

                     on Beautiful Snowbank Lake

                                                                      near  Ely, Minnesota

Reservation Form

Please print out this form, fill it out, and mail it back to us...........

Or call us at     218-365-5700

with the  information requested below.

Jackpine Lodge

Box 570

Ely, Minnesota 55731

Name ______________________________________________________________________

Address ____________________________________________________________________

City, State & Zip _____________________________________________________________

Phone number with area code ____________________________________________________

E-Mail address _______________________________________________________________

Please reserve a _____bedroom cabin for ______week(s) for a party of _____adults, _____children.

Children's ages ______, ______, ______, ______, ______. We will need a crib ____ yes, _____ no

We will need ______ boat(s) and ______ motor(s). We will be bringing our own boat ____ yes, _____ no

We will arrive on ___________(month) _______ (day) 2004

We will be bringing a pet(s) _______ yes, _______no

Deposit enclosed $_____________ Check # __________ or if you prefer............

Credit Card : _________ Visa ____________ Mastercard __________ Discover

Card # __________ / __________ / __________ / __________ Expires ________ / ________

Signature _______________________________________________
(must be signed)

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