Desert Sand

Credit Card Authorization Form

*Please do not submit this form unless you have been instructed to do so by our reservation specialists. 

* Required Fields
First Name *
Last Name *
Address *
Address 2 *
City *
State *
Zip *
Phone *
Email *
Credit Card Security Code (3 digits) *
Deposit Amount *
Check In Date *
Check Out Date *
I have read and agreed to the Motel Policies and give the Desert Sand Motel permission to charge my credit card for the deposit amount entered above. *
I understand that misrepresentation of any information will void my reservation. *