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	

Hours of Operation: ____________________________________________________________________

Fees: ________________________________________________________________________________
_____________________________________________________________________________________

Facility Description: ____________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________
Amenities:    □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
ADA Accessible:    □Yes □No

Public Contact Info	

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

Directions from Nearest Route (highway)	

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

Map URL: _________________________________________________________

Directions from Route: __________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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
 □ Paid Online

Regular 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
Questions? Call Harry Falisec at 1-800-574-9397.
FAX 503-378-6282