Accommodations
Registration Request Form (If you would simply like
to make an inquiry, please use our Contact form.)
"I've had good luck with your website!"
- P. Jones
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. **
