Selva Negra Ecolodge Reservations Request/title> <link rel="stylesheet" href="../css/stylesheet.css" type="text/css" /> <script type="text/javascript" src="../js/script.js"></script> <script src="../SpryAssets/SpryMenuBar.js" type="text/javascript"></script> <link href="../SpryAssets/SpryMenuBarHorizontal.css" rel="stylesheet" type="text/css" /> </head> <body>  <div id="pagewrapper">  <div id="header"> <div class="header_r"><br /> <p><a href="a_search.html">Search</a><p/> </div> <div class="logo"><a href="../index.html"><img src="../images/green-logo.png" alt="Logo" width="110" height="85" border="0" /></a></div> </div>  <div class="clear" /> </div>  <div id="menu"> <ul id="MenuBar1" class="MenuBarHorizontal navigation">  <li><a class="MenuBarItemSubmenu" href="l_lodge.html">ECOLODGE</a> <ul> <li><a href="g_lodge.html">Ecolodge Photo Gallery</a> <li><a class="MenuBarItemSubmenu" href="l_lodging.html">Lodging</a> <ul> <li><a href="g_lodging.html">Lodging Photo Gallery</a></li> <li><a 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href="a_phil.html">Sustainable Philosophy</a></li> <li><a href="a_hist.html">Lodge History</a></li> <li><a href="a_bio.html">Bios</a></li> <li><a href="a_direc.html">Directions</a></li> <li><a href="a_contact.html">Contact Us</a></li> </ul> </li> </ul> </div>  <div class="clear"></div>  <div class="subheader"> <h1>Reservations | We look forward to hosting you</h1> <p></p> </div> <div class="breadcrumbs"> <a href="../index.html">Home</a> <a href="l_lodge.html">Reservations</a></div> <div id="content">  <div id="leftcontent"> <div class="contentcol">  <h1>Reservation Request</h1>  <p>In order for us to process your reservation request all fields must be completed. You will be contacted by a reservations agent to confirm your reservation. For group reservations or events, please contact us directly at: <a href="mailto:reservaciones@selvanegra.com.ni"> reservaciones@selvanegra.com.ni</a></p>  <FORM FROM NAME ="Reservations" METHOD="POST" ACTION="http://www.selvanegra.com/cgi-bin/cgiemail/cheeseFormTest/cheeseOrder.txt">  <table> <tr> <td>First name:</td> <td><input type="text" name="first_name" value="" maxlength="100" /></td> <td>Last name:</td> <td><input type="text" name="last_name" value="" maxlength="100" /></td> </tr> <tr> <td>Check-in Date:</td> <td></td> <td>Number of nights:</td> <td> <select> <option value ="1 Nights">1</option> <option value ="2 Nights">2</option> <option value ="3 Nights">3</option> <option value ="4 Nights">4</option> <option value ="5 Nights">5</option> <option value ="6 Nights">6</option> <option value ="7 Nights">7</option> <option value ="More">More</option> </select> </td> <td></td> </tr> <tr> <td>Adults:</td> <td> <select> <option value ="0 Adults">0</option> <option value ="1 Adults">1</option> <option value ="2 Adults">2</option> <option value ="3 Adults">3</option> <option value ="4 Adults">4</option> <option value ="5 Adults">5</option> </select> </td> <td>Children:</td> <td> <select> <option value ="0 Children">0</option> <option value ="1 Children">1</option> <option value ="2 Children">2</option> <option value ="3 Children">3</option> <option value ="4 Children">4</option> <option value ="5 Children">5</option> </select> </td> </tr> <tr> <td>Prefered Lodging:</td> <td> <select> <option value ="You Pick">Please help me pick</option> <option value ="One Bed">One Bedroom Bungalow US$85</option> <option value ="Two Bed">Two Bedroom Bungalow US$95</option> <option value ="Three Bed">Three Bedroom Bungalow US$140</option> <option value ="Four Bed">Four Bedroom Bungalow US$165</option> <option value ="Five Bed">Five Bedroom Bungalow US$190</option> <option value ="Hotel">Hotel Style Room US$45-75</option> <option value ="Youth">Youth Hostel US$15 per person</option> </select> </td> <td></td> <td> </td> </tr> <td>Special Requests:</td> <td COLSPAN="3"><textarea rows="3" cols="50" name="comments"></textarea></td> </tr> <tr><td> </td> <td><input type="submit" value="Submit" /></td> </tr> </table> </div> </div>  <div id="rightcontent">  <div id="sidebar"> <div id="menu1"> <p>Find out more about Selva Negra Ecolodge:</p> <ul> <li><a href="l_lodging.html" title="Eco Lodge Lodging Options">Lodging</a></li> <li><a href="l_activities.html" title="Eco Lodge Activities">Activities</a></li> <li><a href="l_dining.html" title="Eco Lodge Dining">Dining</a></li> <li><a href="l_sustainable.html" title="Eco Lodge Sustainable Efforts">Sustainable Efforts</a></li> <li><a href="g_lodging.html" title="Photo Gallery">Photo Gallery</a></li> <li><a href="l_faq.html" title="FAQ">FAQ</a></li> <li></li> </ul> </div>   <h3>  <br /> </h3> </div> </div>  <div class="clear"></div> </div>  <div class="clear"></div>  <div id="footerbg"> <div id="footer"> <ul class="navigation"> <li class="current"><a href="../index.html">Home Page</a></li> <li><a href="a_aboutus.html">About Us</a></li> <li><a href="e_events.html">Events</a></li> <li><a href="l_lodge.html">Ecolodge</a></li> <li><a href="n_reserve.html">Nature Reserve</a></li> <li><a href="c_coffee.html">Coffee Estate</a></li> <li><a href="a_gallery.html">Gallery</a></li> <li><a href="#">Blog</a></li> <li><a href="a_contact.html">Contact Us</a></li> </ul> <br /> <br /> </div>  </div> </div>  <script type="text/javascript">  </script> </body> </html>