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Name(s):

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

 (5 digits)

Daytime Phone:

Evening Phone:

Email Address:

Best time/way to reach you:

Check-in Date:

Check-out Date:

Front Room (Two Twin Beds, Shower):

No Yes  $65.00 per night

Middle Room (Queen Bed, Tub/Shower Combo):

No Yes  $65.00 per night

Back Room (Queen Bed, Jacuzzi Tub):

No Yes  $65.00 per night

Apartment (Queen Bed, Full Kitchen, Den, Shower with Built-in Seat):

No Yes  $65.00 per night

Event Space:

No Yes $200 (up to 4 hours)
            $300.00 (all day)

Number of Guests:

Comments: