Chimneys Guest House Breakfast Order Form

1

Full Name* This field is required.

First Name

Last Name

2

Please verify that you are human* This field is required.

3

Phone Number* This field is required.

Country Code

Phone Number

4

E-mail* This field is required.

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

5

Breakfast date and time Please choose your breakfast date and time. Please come to the Dinning Room exactly on time to avoid your breakfast getting cold.

6

Breakfast options* This field is required.Please choose your option. Description of our breakfast options are available at www.chimneys-guesthouse.com/facilities

English

Indian

French

American

Vegan

8

Drinks optionSelect 1 cold and or 1 hot drink from the list.

Orange juice (cold)

Apple juice (cold)

Cranberry juice (cold)

Milk (cold)

Tea (hot)

Coffee (hot)

9

Do you have any known food allergies or are intolerant to any food or beverage?* This field is required.If you have any known food allergies or are intolerant to any food or beverage items, please speak to us. Please be aware that we handle allergens on our premises.

YESNO