TripCheck – Lodging Form

Part 1: Business Name and Public Street Address (information released to the public)	

**All items in bold must be filled in***

Business Name: ________________________________________________________________
Street Address: ________________________________________________    Suite: ________
City: ______________________     State: Oregon     Zip: ____________
Service Type (select one):    □ Bed & Breakfast   □ Camping   □ Hotel   □ Motel   □ Resort   
□ RV Park   □ Suites   □ Other, Specify: ______________________________________________
□ Do not display for this listing
             
Part 2: Business Profile (information released to the public)	

**All items in bold must be filled in***

Facility Description	

ADA Accessible:    □Yes □No
Hours of Operation: (1 paragraph, 250 characters max.) ____________________________________________
_____________________________________________________________________________________

Fees: (1 paragraph, 250 characters max.) _________________________________________________________
_____________________________________________________________________________________

Facility Description: (1 paragraph, 400 characters max.) ____________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Amenities:    (can only show items from this list)    □Air Conditioning    □Business Service Center    □Cable TV    □Exercise Equipment    □Free Breakfast    □Golf    □High-Speed Internet    □Kitchen    □Kitchenettes    □Movies    □Newspaper    □Restaurant    □Room Service    □RV Facilities    □RV Friendly    □Spa
□Swimming Pool    □Trucker Facilities    
Payment Options:    □Cash   □VISA   □MasterCard   □Discover   □American Express   □Check

Public Contact Info	

Phone: __________________     Toll-Free: __________________     Fax: __________________     Email: ___________________     Website: ____________________________________________  

Directions from Nearest Route (highway)	

Route: _______   Milepost: ______   Longitude: __________________   Latitude: _________________ 

Map URL: ____________________________________________________________________________

Directions from Route: (1 paragraph) ________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
We can also include a small picture, or logo, for your business. (We are limited to a picture width of no more than 150 pixels but will be happy to resize your picture for you.)

Part 3: OTE Business Contact (not released to the public)	

**All items in bold must be filled in***

Primary Contact Info	

First Name: _________________________     Last Name: _________________________   
Phone: _____________________________     Fax: _______________________________                 
Email: ______________________________

Alternate Contact Info (optional)	

First Name: _________________________     Last Name: _________________________   
Phone: _____________________________     Fax: _______________________________                 
Email: ______________________________

Owning Business and Mailing Address	

□ Same as the public business name and street address?

Owning Business Name: _________________________________________________________________
Address 1: __________________________________   Address 2: _______________________________
City: ______________________     State: _______________     Zip: ___________

Payment method:
□ Check Enclosed
□ Invoice Me

Subscription rate: $ 150.00 per year. 
Mail your completed form to:
Oregon Travel Experience
ATTN: Tripcheck Link Subscription
1500 Liberty St, Se, Suite 150
Salem OR 97302-4609

or
				
Email: info@oregonte.com 		Questions? Call 1-800-574-9397 and choose Sue VanHandel or zero for Operator

or

Fax:  503-378-6282