Yaq Internet Application Submission Form
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Please fill in the following fields below, so we can process your order.
A representative from Yaq Internet will call you directly once the order is processed.
Note: Please do not submit credit card details, or other sensitive financial information via this form.
At present, it is our policy not to accept order payments made via the internet, although this may change at a later date.
We will invoice you once the order is processed. Please allow 14 days for order processing.
Confused about how to fill out this form? Click here to find out more.

Your Email Address 
Your Name 

Proprietor Name
Business Name
Billing Address
Zip Code (if applicable)
Telephone 1
Telephone 2
Mobile Phone
Internet Home Page

Proprietor Name
Business Name
Zip Code (if applicable)
Telephone 1
Telephone 2
Mobile Phone
Internet Home Page

American Express
Diners Club

Accessibility for disabled persons All Rooms Non Smoking
Facilities for disabled with helper Smoking Zones Available
Elevator/Lift Non-Smoking Zones Available
Orthopaedic Beds Tea and Coffee Making in Rooms
Children's Playground Full Bar
Children's Playroom Wine Bar
Babysitter Service A la Carte Menu
Creche Vegetarian Catering
TV in all Rooms Evening Meals Available
In house Cable/Sattelite TV Hairdryers in all Rooms
Internet Access for guests Car Parking Facilities
Direct Dial Phones Electric Blankets

Unusually Scenic Area
Unusually Historic Area
Close to Castle or Folk Park
Close to Celtic Monument
Proximity to Heritage Centre
Gaeltacht Area

Close to Shopping Area
Close to Arts/Crafts Centre
Close to City Transport
Close to Theatre
Close to Cinema
Close to LeisurePlex
Fax Facilities
Photocopying Facilities

Pets Welcome
Peat Fires
Home Baking
Speciality Seafood
Laundry Facilities
Email Bookings Accepted

Evening Entertainment Outdoor Pool Squash Courts
Traditional Music Surfing Badminton
Ballad Sessions Windsurfing Horseriding
Rock Music Venue Sailing Pony Trekking
Panoramic Views Diving Golf Course
Nightclub Angling Pitch and Putt
Pub Deep Sea Fishing Mountain/Rock Climbing
Beach Waterskiing Hill Walking
Indoor Pool Gymnasium Nature Trail
Tennis Courts Motorsports

Evening Entertainment Beach Badminton
Traditional Music Indoor Pool Squash
Ballad Sessions Outdoor Pool Horse Riding
Modern Music Sauna Pony Trekking
Panoramic Views Jacuzzi/Hot Tub Golf Course
Picturesque Gardens Massage Pitch and Putt
Seafront Property Gymnasium Angling
Lakefront Property Games Room Tennis Court

B and B pps Min Total Number of Rooms
B and B pps Max Number of Ensuite Rooms
Partial Board pps Min Number of Family Rooms
Partial Board pps Max Open From
Single Using Double Min Open Until
Single Using Double Max Open All Year
Single Room Min Closed During Christmas
Single Room Max Travel Agency Vouchers
Percentage Reduction Child

Awards and Approvals Received

Please give a brief summary of your business to appear on the internet ( 100 words approx. )

Summarise your business into one sentence.

French Italian Portuguese
German Spanish Dutch
Other Gaeilge

By clicking the submit button below, I certify that the information hereby submitted is correct to the best of my knowledge, and I accept that Yaq Internet, any associates and employees thereof are not responsible for any errors or omissions which have been erroneously or otherwise submitted on this form.