Accommodations
Registration Request Form (If you would simply like
to make an inquiry, please use our Contact form.)
"Thank you for your assistance as we continue to make reservations through your service."
- J&S Smith
Please fill out the following information about your stay in a Bed & Breakfast/Resort accommodation in the MidWest associated with B&B MidWest Directory.
PLEASE NOTE: Filling out this form does not represent a confirmed reservation. Cancellation policies according to terms of particular reserved accommodation.
You will be contacted regarding a room availability to match your request!
First Name:
Last Name:
First
& Last names of other occupants:
Number of children
in party:
Children's age range:
Street Address:
City, State, Zip Code:
Home Telephone:
Office Phone:
FAX:
E-mail:
Items in bold MUST be completed.
Optional
Employer:
Employer's Street Address:
City, State, Zip Code:
Travel Information
Arrival Date:
Arrival Time:
Departure Date:
Location Information:
Transportation Method:
Items in bold MUST be completed.
Accommodation Information
How were you referred to B&B MidWest Directory?:
Purpose of trip:
Should this be kept a surprise from other guest(s)?:
No
Yes
Special Request:
Jacuzzi
Fireplace
Private Bath
2 or more rooms
Double/1 Bed
King/Queen Bed
Non-Smoking
Smoking
Full Breakfast
Handicap Provisions*
Pets*
Allergies*
*Please detail your specific situation below
Other Request:
Please note: An attempt will be made to meet all special requests but you will be informed when a particular need can not be made by the location you have requested.
Please answer:
Reservation Inquiry
Your request will be filled on a first come first serve basis. The individual host will call you at the number(s) provided above or contact you via email to confirm your reservation.
** B&B MidWest Directory is a FREE SERVICE for MidWest bed and breakfasts. No additional fees are ever added. **
