LAMPLIGHTER MOTEL RESERVATION FORM
Name:
Mailing Address:
City, State & Zip:
Country:
Phone:
E-Mail Address:
Requested Number of Rooms
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Requested Bed Type
Please Select
Queen
Twin
Number of Adults:
Number of Children:
Pets:
Yes
No
Arrival Date:
Departure Date:
Comments or Questions?:
Completion and submission of this form does not constitute a confirmed reservation, only a request for a reservation or information.
