Please complete and sumbit the following form to request a reservation with one of our Service's bed and breakfasts. We will send your reservation confirmation, host B&B address and phone number by postal mail or fax as you request. Fax requests still require a mailing address be provided in case we have difficulty with your fax number. To make a booking with one of our Independent B&Bs you must contact them directly. Also, please be sure to review our Cancellation Policy Alternatively you may call or fax us toll free at 905-356-9037. Fields marked with asteriks (**) must be completed.

Full Name:** Phone Number:** Provide best number to reach you. E-Mail Address:** Number of People:** Number of Rooms:** Number of Nights:** Type of Room(s) Preferred:** Twin Double Queen King Preferred Arrival Date:** e.g. Friday, July 3, 1998 Preferred Departure Date:** e.g. Monday, July 6, 1998

First Choice of B&B:** Any B&B Any B&B in Niagara-on-the-Lake Amberlea Bide-A-While Burke House Dorchester House Edel & Ray Pierce's Country Home Grand Victorian Hiebert's Guest House Maria's French Country Manor Omi's Haus The Post House The River Breeze The Rose & The Shamrock Skyehaven Stillacres Wishing Well Cottage Yolanta's Bed & Breakfast ------------------------------- Any B&B in Niagara Falls Butterfly Manor Fairbanks House Niagara Falls Guest House ------------------------------- Any B&B in Niagara Region Inn on the Henley Peach Tree Bed & Breakfast Tudor Creek House Second Choice of B&B:** Any B&B Any B&B in Niagara-on-the-Lake Amberlea Bide-A-While Burke House Dorchester House Edel & Ray Pierce's Country Home Grand Victorian Hiebert's Guest House Maria's French Country Manor Omi's Haus The Post House The River Breeze The Rose & The Shamrock Skyehaven Stillacres Wishing Well Cottage Yolanta's Bed & Breakfast ------------------------------- Any B&B in Niagara Falls Butterfly Manor Fairbanks House Niagara Falls Guest House ------------------------------- Any B&B in Niagara Region Inn on the Henley Peach Tree Bed & Breakfast Tudor Creek House Third Choice of B&B:** Any B&B Any B&B in Niagara-on-the-Lake Amberlea Bide-A-While Burke House Dorchester House Edel & Ray Pierce's Country Home Grand Victorian Hiebert's Guest House Maria's French Country Manor Omi's Haus The Post House The River Breeze The Rose & The Shamrock Skyehaven Stillacres Wishing Well Cottage Yolanta's Bed & Breakfast ------------------------------- Any B&B in Niagara Falls Butterfly Manor Fairbanks House Niagara Falls Guest House ------------------------------- Any B&B in Niagara Region Inn on the Henley Peach Tree Bed & Breakfast Tudor Creek House Send Confirmation by Fax or Mail? Fax Mail If by Fax - Fax Number: Mailing Address:** Still required for fax requests. Additional Comments: Anything else we should consider or know about regarding your reservation request.

Credit Card Information A deposit of $25.00 per day Canadian (e.g. 3 nights = $75.00 deposit) is required to confirm a reservation. As we are currently not on a secure site you may opt to omit the Credit Card information with this request. In that case we will respond to your reservation request by e-mail as a preliminary booking. To confirm your booking and receive a confirmation you must then call or fax us with your credit card number. As a point of interest, however, the chances of your credit card information being intercepted over the Internet (secure or unsecure) are no more or less than by giving it by fax or phone. Type of Credit Card Visa MasterCard American Express

Credit Card Number:	Expiry Date: e.g. 10/98

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