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*First Name

*Last Name

*E-mail Address

*Verify E-mail Address

*Phone Number

*LoyalGuest.com Membership

*Hotel Name

*Reservation Number

*Arrival Date

*Departure Date

*Room Type Name

*Total Rate on hotel website(without tax & fees):

*Total Competing Rate Found (without tax & fees)

*Competing Price Website(URL):

*Room Type Name

* Number of Night at Competing Rate