NAME:_______________________________________________________________________

ADDRESS:____________________________________________________________________

TELEPHONE NUMBER: ______________________________

E-MAIL: __________________________________

PREMISES REQUESTED (Check all that apply):

• Entire Guesthouse
• First Floor only (all rooms)
• First Floor Bedroom/Full Bath
• First Floor Dining Room/Office
• First Floor Front Room/Parlor
• First Floor Kitchen
• Second Floor only (all bedrooms)
• Second Floor Bedroom 1 (King Bed)
• Second Floor Bedroom 2 (Full Bed)
• Second Floor Bedroom 3 (Full Bed)
• Second Floor Bedroom 4 (Murphy Bed)

RESIDENTIAL USE? YES ___ NO ___    BUSINESS USE?* YES ___ NO ___

*If "yes", describe use __________________________________________________________________________

SPECIAL FURNISHING NEEDS __________________________________________________________________

___________________________________________________________________________________________________

LENGTH OF STAY _____ STARTING DATE _____ ENDING DATE _____

NUMBER OF PERSONS STAYING AT GUESTHOUSE _____

NUMBER OF MOTOR VEHICLES USING PARKING LOT _____

USE OF LAUNDRY ROOM REQUESTED? YES _____ NO _____

USE OF RECREATION ROOM REQUESTED? YES _____ NO _____

USE OF ATTIC ROOM REQUESTED? YES _____ NO _____

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