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Periwinkle Motel
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The Gulf Motel
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First Name:
Last Name:
Address:
City:
State:
Zip Code:
Telephone:
E-Mail:
Arrival:
January
February
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Departure:
January
February
March
April
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June
July
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September
October
November
December
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2010
Smoker:
Yes
No
Adults:
1
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3
4
5
6
Children:
0
1
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3
4
Other Comments:
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