fields marked * are required to be filled in

Reason for completing this form:     Enquiry     Booking*

Contact Details

Title:	--select-- Mr Mrs Miss Ms Doctor *
First Name:	*
Surname:	*
Address:	*
Suburb / Town:	*
Postcode	*
Country:	--select-- Australia Other Country *
If other country please specify
Telephone:	*
Mobile
Fax:
Email Address:	*
Preferred method of reply	---Select--- Email Phone Mail Fax *
If phone specify best time	Anytime   Business Hours (9 to 5) After Hours

Accommodation Details

Proposed Arrival Date:
Proposed Departure Date:
Number of Guests:
Accommodation Style: (Please select)	---Select--- n/a Bed and Breakfast Suite The Barn *
Special Requests / Comments:	*
To assist our marketing could you please fill out the details below
How did you find out about us?	---Select--- Print Advertising Repeat Visit Referral Internet Brochure Other *
If other please specify
If Internet please specify	Search Engine  Accommodation Website
Thank you for your assistance with our marketing
Please enter verification code as you see it:	*