Overnight Room Request Information (* indicates required information)asterisk denotes 

* Requestor (Employee Name):   

* Phone #:    * Fax #:   * E-Mail: 

* Department:    

Department Address:

Services requested: 

Room Reservation           Number of Rooms for this reservation:

Guest Group Name (applies when multiple guests are booked under one group name):

Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  
Guest Name:     Arrival date:    # of nights:  

Please check all charges that are allowable for indicated Guests: 

Room - billed to Guest  

Room - billed to Wesleyan department (please enter account number below)

Meals ( indicate which meals apply)       

Complimentary Breakfast (when applicable)

Other - please specify:
 

    Please detail other comments or requests here

Meeting Room Request Information:

Meeting Room(s)         # of attendees:     Requested room requested: Meeting Room A Meeting Room B Conference Room  

Food      Please choose from the following 
                    (to choose more than one, hold down control key and select):    Breakfast Lunch Dinner Snacks Other  

Brief description of Event (please indicate any special needs): 

Billing information and authorization:

* Account Number (6 digit) to be charged for this service request: