BOOKING FORM

Name:

Members of the party excluding person named above
Title
First Name
Surname
Age if under 18
       
       
       
       
       
       
       
       
       
       


Address:
Postcode:
Telephone: Mobile:
E-mail
Property Required:
Date of Arrival: Date of Departure:
No. of Nights:
Travel Cot req'd.: High Chair req'd.:
How did you hear about us?

I hereby agree to be bound by the booking conditions
Signature:                                  Date:
(Any payment received automatically accepts the booking conditions)
Tariff for Holiday:         £ ...............
          Amount Due  Either: If less than 6 weeks to arrival, the Full Amount:        £  ..................      
                                              OR: 1. If more than 6 weeks to arrival, 1/3 Deposit:       £  ..................      
                                     2. Pets (£4.00 per night)                              £  ..................      
     Payment Payment now due:  £............                  EITHER: I enclose my cheque payable to 'CHAMPERNHAYES' for the required amount
     Or: Please debit my:    Mastercard/Visa/Meastro/Debit              Card Number:
     Valid from:          Expiry date:          Issue Date: (Maestro only)           Security No.
                                                                                                                                               (last 3 digits on reverse of card)
     Credit Card Billing Address (if different from above) :                                                                                       I hereby authorise 'CHAMPERNHAYES' to charge my account with my deposit/full payment: £  .............
     Also my balance payment - chargeable 42 days prior to arrival:                                           £  ..............
      Cardholders Name:                                   Cardholders Signature:
       Return to:   Mr T. Dutton, 22 Ringley Park Avenue, Reigate, Surrey. RH2 7ET.
    As part of our membership of Premier Cottages, we allow Premier Cottages to mail our guests their brochure.    Names and addresses are not passed to any other organisation. Should you wish NOT to be mailed a Premier    Cottages brochure please tick here.
OFFICE USE Booking Ref:.............
     Confirmation of the above booking: ....................................................
     The Balance: £  ...............................................................Cheque Payable to 'CHAMPERNHAYES'
     Please return this slip with payment before: ..............................
     To Mr T. Dutton, 22 Ringley Park Avenue, Reigate, Surrey, RH2 7ET.
                                                             VAT Number