Creswick Campus Residential Services

Booking Form for Accommodation – Individuals

Arrival Date:	Enter arrival date here

Departure Date:	Enter departure date here

ETA:	Choose a time	No. of People:	Choose a number

Preferred Room Type:	Choose a room type here

Preferred Room No.:	Enter up to 3 room numbers

Have you stayed at the Creswick Campus before:	Please select

Car Registration No.:	Enter rego no. here if applicable

TITLE:	Please select

FIRST NAME:	Enter your first name here

LAST/FAMILY NAME:	Enter your last name here

Preferred Name:	If applicable	Gender:	Please choose

UoM Student:	Please choose	Student No.:	Enter student no.

UoM Staff:	Please choose	Staff No.:	Enter staff no.

IF YOU ARE NOT A UoM STUDENT OF STAFF MEMBER, PLEASE PROVIDE A COPY OF YOUR PHOTO ID WITH YOUR BOOKING FORM

Organisation Name:	Enter organisation name if applicable

Mailing Address:	Enter address details here

Town/Suburb:	Enter town here	Country:	Enter country here

State/Territory:	Please select	Postcode:	Enter postcode

Phone No.:	Enter phone here	Mobile No.:	Enter mobile here

Email address:	Enter uni email address here if applicable

Alternate email:	Enter other email address here if applicable

Home Country:	Enter your home country, if not Australia

Reason for staying at Creswick:	Please give reason

Any special requirements:	Please enter special requirements, if any

PAYMENT METHOD:	Please select

Credit Card Details (if applicable):

Name on Card:	Please enter the name on the card

Credit Card No.:	Please enter number with spaces eg. 1234 5678 1234 5678

Expiry Date-Month:	Select month	Year:	Select year

Organisation Details for invoicing (if applicable):

Organisation Name:	Enter organisation name here

Mailing Address:	Enter organisation mailing address here

Contact Person:	Enter name of contact person	PO #:	If required on invoice

Themis Code (if applicable):

Full account string:	Enter full account string eg. 01-2200-15-xxxx-000000-GEN-12-17

PLEASE SAVE THIS FORM AND RETURN BY EMAIL TO:

creswick-accom@unimelb.edu.au

OFFICE USE ONLY:

Booking Taken:	Enter booking date	Taken by:	Enter your name

Booking Entered:	Entered date	Entered by:	Enter your name

Room No. allocated:	Enter room no.	Rate in $:	Enter nightly rate

Other Information:	Enter any special details or notes here