BOOKING FORM

Name of Person booking:
Address:			Post/Zip code:		Contact No including STD:		Email:
Please list all persons in your party including those aged under 21.
Title	Initials	Surname				Age (If under 21)
Rental Details
From (DD/MM/YY)				To (DD/MM/YY)
Total number of nights  :
2 or 4 Bedroom House :
I have read and agree to the booking conditions (details on website), confirm that I am over 21 years of age and would like to confirm my reservation as shown above.  I enclose a cheque made payable to Mr & Mrs R L Evans for deposit (₤100 per week)/ full payment or balance of payment.
Cheque enclosed for ₤_____________
Please contact us to check availability before sending your deposit cheque.  Please  forward  monies in pounds sterling to 221 Barford Street, Highgate, Birmingham, B5 7HE.England. Any queries, please telephone us on 07860 586214 or fax on 0121 622 4457 Dialling code  from USA 01144 7860 586 214 or  fax 01144 121 622 4457

Signature              ________________________________________

Date        __________________________            Print Name            ________________________________________