Food & Drink Application Form

AccessIreland.info 32 Ard Fatima, Clonmel, Co. Tipperary, Ireland. +353 (0)87 1232053 access@accessireland.info

Please fill out all relevant fields.
Business Name:		______________________________________________
Address:		______________________________________________
Town / City:		______________________________________________
Dublin Code: ( Where applicable )		______________________________________________
County:		______________________________________________
Post Code: ( Where applicable )		______________________________________________
Contact Name:		______________________________________________
Telephone:		______________________________________________
Fax:		______________________________________________
Email:		______________________________________________
Website Address:		______________________________________________
Sub-Category:		Cafés Pubs Pubs/Restaurants Restaurants Take Aways
Suggest a Sub-Category:		______________________________________________
Description: Example: Parking available adjacent to housewith 2 steps to main entrance 100 mm and 140 mm high. Spacious interior with four ground floor accessible bedrooms. Main bathroom and toilet are accessible. Grab rails fitted. Guide dogs permitted.		______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

		Wheelchair Accessible.			Wheelchair Accessible with an Assistant.
		Accessible to someone with mobility difficulties, but able to walk up a minimum of three steps.			Guide Dogs allowed.
		Access for Individuals Who are Blind or Have Low Vision.			Sign Language Interpretation.
		Accessible Print.			Printed matter available in Braille.
		Fully accessible disabled toilet.			Accessible Telephone.
		Grab Rails Fitted.			Accessible Ramps.
		Audio Visual aids available.			Wheelchair accessible Reception / Service Desk.