Request Form

Name:

Mr. Mrs. Ms.

Address:

City, State, Zip:

Phone:

E-mail:

Date of Arrival (month, day, year)

Date of Departure (month, day, year)

Number of Guests Adults 1 2 3 4 Children over 3 0 1 2 3 4

Room Type $90.00 - Shared Bath $100.00 - Private Bath $120.00 - Honeymoon Suite

Preferred Room Amenities:
Canopy Bed    Fireplace    Balcony Access    Ball & Claw Tub

Are you planning a special event, such as a wedding, corporate retreat or theme dinner? Yes    No

If so, please describe your event (type of event, number of people invited, whether catering is needed, type of seating/tables needed, number of guest rooms needed, etc.):

Please add any comments, questions, or special requests here: