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B&B MidWest Directory
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Accommodations Registration Request Form
(If you would simply like to make an inquiry, please use our Contact form.)
"B&B MidWest Directory found us exactly what we wanted! Many thanks." - D&W Hancox

Please fill out the following information about your stay in a Bed & Breakfast/Resort accommodation in the MidWest associated with B&B MidWest Directory.
PLEASE NOTE: Filling out this form does not represent a confirmed reservation. Cancellation policies according to terms of particular reserved accommodation. 
You will be contacted regarding a room availability to match your request! 
Host Location:

First Name:Last Name: 
First & Last names of other occupants:  
Number of children in party: Children's age range:  
Street Address:  
City, State, Zip Code:       
Home Telephone:Office Phone:FAX:E-mail: 
Items in bold MUST be completed. 
Employer's Street Address:  
City, State, Zip Code:       
Travel Information 
Arrival Date:Arrival Time:Departure Date: 
Location Information:Transportation Method: 
Items in bold MUST be completed. 
Accommodation Information 
How were you referred to
B&B MidWest Directory?:
Purpose of trip:  
Should this be kept a surprise from other guest(s)?: No Yes 
Special Request:
Jacuzzi  Fireplace  Private Bath  2 or more rooms 
Double/1 Bed  King/Queen Bed 
Non-Smoking  Smoking  Full Breakfast 
Handicap Provisions*  Pets*  Allergies* 
*Please detail your specific situation below
Other Request:  
Please note: An attempt will be made to meet all special requests but you will be informed when a particular need can not be made by the location you have requested. 
Form Submission  
Your request will be filled on a first come first serve basis. The individual host will call you at the number(s) provided above or contact you via email to confirm your reservation.  
  ** B&B MidWest Directory is a FREE SERVICE for
MidWest bed and breakfasts.
No additional fees are ever added. **

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