Name(s) ___________________________________________E-mail: ___________________________________
    
  Residence: __________________________________________________________________________________

  Home Phone: _________________Business Phone: ____________________Fax: _______________________

  Business Address: ____________________________________________________________________________

  Passport #_____________________________  Arrival Date & Time: __________________________________
 
   Airline, flight# & Arrival terminal:___________________Depart. Date & Time:_________________________

   No. of Guests (Adults):_____ (Children) _____ No. of Boys ____ Girls ____ Ages:_________________________

   Choose service needed:  [    ] Hosted B&B   [    ] Private Accommodation 

   Number the priority of areas you prefer (1 means the first priority).  Specify at least three:
  [    ] Upper East            [    ] Upper West          [    ] Midtown East        [    ] Midtown West   
   [    ] Greenwich Village    [    ] Roosevelt Island    [    ] Brooklyn Heights 

   Maximum daily rate: _____________  Is private bath required?________  No. of Bedrooms ____________ 

   No. of Beds: ______________           Bed Size:  [    ]Twin    [    ]Full    [    ]Queen/King    [    ]Doesn't matter 
   
   Do you smoke?___________             Do you require a non-smoking accommodation?_____________
 
   Allergies (pets, down pillows, etc.): ______________________________________________________________

   Credit Card:   [    ] Visa   [   ] Master   [   ] Amer. Express.  

   Card Number: _____________________________________________Exp. Date: ________________________ 

   Issuing Bank: ________________________________________________________________________________

   How did you learn of our service? ______________________________________________________________

 At Home In New York, its owners/agents/employees are merely acting as coordinators of temporary lodging  for 
guests. I (we) acknowledge that this is their only function and obligation, and they shall not be held responsible 
for any loss, injury, damage or delay incurred as a result of any act or omission, whether negligent or not,  of any 
person(s) rendering services or accommodations herein.

 Signature: ___________________________ Date: __________________________________