BOOKING FORM for La Petite Grange

(Please print off this form, complete and send with your 20% deposit  or  full payment if less than six weeks of arrival.)

Please make sure you have read our TERMS AND CONDITIONS on the Booking page of our website

Title:............... Surname:....................................................................... Forename:..............................

Address:..................................................................................................................................................

Postcode:......................................................................  Country:..........................................................

Daytime Tel No: ........................................   Evening Tel No:..............................................................

Email address:.......................................................................................................................................

All other members of your party (We regret no pets allowed without prior agreement.)

Title

Initials

  Surname

Age (if under 18)

PLEASE NOTE: All bookings run from 4pm to 11am.  If you anticipate a later arrival, please let us know.

CONDITIONS OF PAYMENT: payment secures your booking but is non-refundable in case of cancellation.

Date Required   From  ......................................   To ......................................   No. Weeks ...........

PAYMENT DETAILS (Cheques in sterling to be made payable to Mrs C. Burnham )

I enclose initial 20% deposit of    €...........................................

I agree to send the balance of    €...........................................

6 weeks prior to the rental period

YOUR SIGNATURE : I declare that I am over 18 years of age. I agree and hereby accept on behalf of myself and all named persons that this booking is made in accordance with the above conditions and to make all payments in relation to these.

Signature   .............................................................................     Date ...........................................

Please send this form - together with your payment to: 

Mrs C. Burnham. Cheyraux,  Lubersac. 19210.   France.

Please retain a copy of this form for your records.