Reservation Request Form

First Name:
Last Name:
Email address:
Phone number:
Fax number:

Number in your party

Location 1
Date In
Date Out
Location 2
Date In
Date Out
Location 3
Date In
Date Out
Location 4
Date In
Date Out

Arrival By:

Bed Preference:

Bathroom Preference:

Please note any special requests, and questions here.

In order to confirm your booking a credit card number is required. A charge of 20% of total nights booked plus 7% GST on that amount is payable to Canada-West after your arrival. The balance is paid in cash or by travellers cheques to the bed and breakfast home, upon arrival.


Which credit card will you be using?

Card Type:

Cardholder Name:
Credit Card Number:
Expiry Date: