Wasa Lakeside B&B Reservation Request

Salutation:
Full Name:
Nickname:

i.e. "Bill" or "Jim"

Company Name:
Department:
Your Title:



Email: Web Site:

Phone 1:
Phone 2:
Phone 3:
Please enter your phone numbers in the order you would like us to try and reach you. i.e. Home first, then Cell, then Work. You would hate to miss out on a reservation because we could not contact you.

Fax
Is this number Private?

Address:
Address:

City:
Province:
Country:

Postal:




How would you prefer to be contacted?

Arrival Date:

Departure Data:

Number of Nights:

Names of Other Adults:

Names & Ages of

Room Choice #1:

Room Choice #2:

Room Choice #3:

Romance Package:

Cancellation Policy: 30 days; less $50.

Comments or Questions: