home

Print and complete this form; post with a cheque for £50.00 payable to Solysombra
Enclose a photo for scanning (free); alternatively enter the URL of an image or photo on the web
Please label reverse of photos with details and POSTCODE!

Click here to sign up online by credit card instead

SolySombra
14 Aiton House
Manchester M16 8AB
 sales@lostpubguide.com

If you have an image on the web you wish to use, you can link to it using our online form - no need to send a photo.

Please complete all sections marked with an asterisk*;
you will receive a password to add more details online at any time.
For your privacy: Your contact name and phone no. will NOT appear unless you specify below
Pub Name *  
Address 1*  
Address 2  
Address 3  
County *  
State/Province  
Postcode *  
Region  
Phone * Show? YES/NO
Fax  
E-mail  
Home Page (if applicable) http://
Image URL (if applicable) http://
Contact name * Show? YES/NO
Beers  
Menu  
Facilities  
Number of bedrooms:  
Cards accepted:  
American Express 
Diners Club 
Visa 
Mastercard 
Switch/Delta 

Description and Directions - use extra sheet if required: