reservation request form

Blue Water Bungalow
"A romantic lakeside cottage~Eureka Springs, Arkansas"

Reservation Request Form
Please fill out the form below and send it to us with your requested dates. We will contact you by phone or e-mail, as soon as possible. For a quicker reply, feel free to call 800-348-0752. Remember, there are discounts for 3 or more night stays and discounted rates for 2 night weekday stays!

Blue Water Bungalow
Reservation Request
Form

Please fill in all the requested fields, as they are very important in helping us reach you about your request. After filling in all the fields, please submit the form and we will get back to you as soon as possible, by phone or e-mail.

First Name:
Last Name:
E-Mail Address:
Verify E-Mail:
Mailing Address:
City:
State:
Zip Code:	(5 digits)
Daytime Phone:
Evening/Cell Phone:
Arrival Date:
Check-Out Date:
	Romantic Getaway - $849.00
	Wedding / Honeymoon $1,195.00 or $1,360.00
	Summer Vacation - $849.00
Credit Card Information: Only enter your card information if you want to make a firm reservation. No card required to simply check availability.	Card Type: Card Number:
Exp Date: i.e. 05/08	CV Code:*
	*The 3 digit number on the back of your card. Usually above your signature line on the right.

	Select your favorite soft drink(s) or bottled water and we will have them waiting for you in the fridge! You can choose something different for each person. Add wine or champagne for $12.00.
	Diet Sprite / Diet 7 UP
	Diet Dr. Pepper
	Diet Coke
	Diet Pepsi
	Sprite / 7 Up
	Dr. Pepper
	Coke
	Pepsi
	Water
	Champagne @ $12.00
	Wine @ $12.00
Comments, questions, requests: If you choose to have us get wine for you, please tell us if you prefer white, red or zinfandel.
Please select this box to verify that you have read, understand and agree to the deposit, cancellation and excessive wear and tear policies.	I have read, understand and agree with policies.

	After submitting this form you will be returned to the Home Page of our site. We will contact you as soon as possible. For a more immediate reply, please feel free to call us at 479-244-5116.

Blue Water Bungalow, is owned and operated by Joe and Laurie Gunnels.
Located on the shores of Table Rock Lake, at Holiday Island, Arkansas.
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