Guest Name
Todays Date
Guest Address
Post Code
Phone
Email
Arrive date
Depart date
How many nights in total
How many people staying overnight in total
Any additional daytime visitors
Rooms	Room 1: 5 Guests (Q,B,S) Room 2: 3 Guests (Q,S) Room 3: 4 Guests (Q,B) Room 3a: 2 Guests (2xS) Room 4: 6 Guests (Q,2xB) All bedrooms
Number Rooms/Beds
Price per person per night
Sub-total
Plus: Prepayment / Bond
Plus: Early Check-in / Late Checkout
Total Payable
Prepayment Amount
Balance Amount
Balance Date
C/O BSL
Additional Meal Info
Booking Confirmed	Yes No
Lodge private booking?	Yes No
Lodge providing breakfast?	Yes No
Will guests self cater lunch?	Yes No
Will guests self cater dinner?	Yes No
Less Prepayment received	Yes No
Early Check-in	Yes No
Late Check-out	Yes No
Dog Staying	Yes No
How Many
Extra Services

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Bilpin Country Lodge – Family Accommodation, B&B and Farm Stay in Bilpin, Blue Mountains. 46 Bilpin Springs Rd, Bilpin NSW 2758. +61 2 4567 0300