Please enter the  date you've selected for your Birthday Pony Party

 Time Selected

Contact person

How did you find us? :

Choose one of the following options:

Customer
Friend
Magazine Advertisement? Which one?

Mag. name
Other?

 

Please provide your information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Cell Phone
Fax
Home Phone
E-mail
Birthday Childs Name
Age becoming on Birthday
Boy or Girl Party?	Boy Girl
# of children attending
# additional children

Choose one of the following options: How do you wish to pay for your Party?

Personal Check payable to Pine View Farm
Cash
Money Order
Credit Card

If there is any thing you feel we should know about your planned reservation  please let us know:

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SECURITY Please type in the numbers 1 through 6

  THIS MUST BE ENTERED OR YOU WILL BE DIRECTED BACK HERE TO ENTER IT.

Please read carefully and sign below

 I have read, understand, and agree that by typing my name below in the "Type Name as Signature:" box and submitting this form to Pine View Farm that I  agree to being contacted for reservation confirmation and payment.

Note: Submitting this form does not confirm your reservation.

Your Party date is NOT secured until deposit is received.

Payment and Deposit Details click HERE

 

Type Name as Signature:    

THIS MUST BE ENTERED OR YOU WILL BE DIRECTED BACK TO ENTER IT.