318 West 20th Street, New York, New York 10011
212.243.4499
800.373.1116
Fax: 212.243.7852
chelsealodge@mindspring.com

Secure Reservation Form

Please be sure to enter your Phone Number or E-mail address correctly
so we may confirm your reservation.


FirstName:
Last Name:
Address:
City:
State:
Country:
Postal Code:
Telephone:
e-mail:
How did you hear about us?
Number of Guests:
Number of Rooms:
Check-In Date:

Check-Out Date:
Check-in time is 3:00pm
Please indicate your approximate arrival time:

Credit Card Required for Reservation. If you don't want to submit your credit card on line, please click HERE.
Credit Card:	Visa Mastercard AmEx
Name On Card:
Card Number:
Expiration Date:
Please note: Due to limited space availability, all reservations will be charged unless cancelled 72 hours before date of reservation.
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