This form must be printed out to be completed then either posted using a European class stamp or emailed, please ask for our address or bank details when reserving your cottage
BOOKING FORM                            La Grange du Moulin         Les Vallaies

COTTAGE:

SURNAME :

ADDRESS :  




TELEPHONE: 
EMAIL:
SOURCE OF ADVERTISEMENT:      chez nous     chez nous     french holiday homes     google      other                                                              brochure       web site                                          search    specify
                                                               
 
DATES OF RENTAL FROM:                                  (from 4pm)
                                     TO:                                 (before 10am)

NAMES OF ADULTS and CHILDREN over 12:



NAMES AND AGES OF CHILDREN  12 years and under




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RENTAL COST:                                                                                        

Please add any OPTIONAL extra services you require:

Change of Linen at �3.50 per person         number of people                                                 
Towels at �5.50 per person                      number of people                                                 
Cleaning charge at �20 or �25                                                                                                   
Video/Dvd hire at �25 per week                                                                                                 
Other - please state
----------------------------------------------------------------------------------------------------------------------------- Total of Optional services                                                                                                         
-----------------------------------------------------------------------------------------------------------------------------
Rental cost plus optional services                                                                                                    
-----------------------------------------------------------------------------------------------------------------------------LESS DEPOSIT  (enclosed �150 per cottage)                                                                       

BALANCE   (payable 10 weeks before)                                                                                  

PLEASE MAKE CHEQUES PAYABLE TO �CHRIS and WENDY BLAKEMAN�

I HAVE READ THE TERMS AND CONDITIONS AND ACCEPT THEM ON BEHALF OF ALL MY PARTY WHO WILL RESIDE IN THE PROPERTY, ON WHOSE BEHALF I AM DULY AUTHORISED TO MAKE THIS AGREEMENT. I HAVE FULLY READ THE WEB SITE AND ALL DETAILS REGARDING THE COTTAGE AND PROPERTY.
I AM OVER 18 YEARS OF AGE.

SIGNED:                                                                       DATE:
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