Hotel Palm Inn - Butterworth Booking Form

Hotel Palm Inn - Butterworth Reservation
Arrival Date & Time*

MonthDayYearHourMinutesAM/PM Option
Departure Date*

MonthDayYear
Room Type*
Numbers of Room*
Smoking/Smoking*
Number of Guest*
Name*

First NameLast Name
NRIC / Passport No*
E-mail*
Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Special Requests
Should be Empty: