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 OR 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:	Credit Card-please provide details below

Please note that we are no longer able to accept cash payments. The first week will be charged to your credit card prior to arrival and each week following, unless you pay in full at Reception.

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