Business Disability Verification

Business Name*

Business Type*

Example Hotel, Guest House, Restaurant, etc

Name*

First NameLast Name

Phone Number

Area CodePhone Number

Mobile Number

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityCounty

Post Code

Web Site Address

Please Provide Up To 3 Images Of Your Business (optional )

Social Online Presence

Parking

	Yes	No	N/A
Disabled Parking Bay
Accessible Parking Close To Entrance
Street Parking
No Parking
Drop Off Point

Access Into Business

Room Accommodation (If Applicable)

	Yes	No	N/A
Disabled Rooms
Accessible Rooms (Ground Level)
Upper Level Rooms
Hand Rails To Upper Level
Lift Access
TV With Sub Titles Available
Large Print Information In Rooms
Bath Only
Bath With Shower
Walk In Shower/Wet Room
Shower Cubicle
Vibrating Pillow Unit
Audible and Flashing Alarm

Public Areas

	Yes	No	N/A
Disabled Toilet Facilities
Assistance Dogs
Induction Loop In Reception
Paper and Pen Readily Available
Level Access
Stepped Access
Ramped Access

Restaurant/Food Facilities (If Aplicable)

	Yes	No	N/A
Accessible Seating
Large Print Menus
Large Print Menus (Available On Request)
Waiter/Waitress Service
Self Service
Outside Seating Area
Level Access
Stepped Access
Ramped Access

Does Your Business Undertake Disability Awareness Training

YesNo

Would You Like To Join The Disability Discount Scheme?

Disability Discount Scheme

YesNoPlease Contact Me

If Yes What Is Your Discount Offer?

Create Your Own Code For Us To Use That You Will Recognise

We will contact you once we have created your free listing to ensure that all the details are correct and you are happy with everything.