Your Name:

____________________________________________________________

Address:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Postcode:

____________________________________________________________

Telephone - Daytime:

____________________________________________________________

Telephone - Evening:

____________________________________________________________

Property:

____________________________________________________________

Arrival date:

____________________________________________________________

Departure date:

____________________________________________________________

Please make cheques payable to COUNTRYSIDE COTTAGES

Brochure price:

£ __________

Booking fee:

+ £ 15.00

Fee for dog:

+ £ 10.00 (if applicable)

Sub total:

£ __________

2.00% if credit
card payment

£ __________

TOTAL:

£ __________ (Due now if within eight weeks of arrival)

Deposit:

£ __________ (30% of total holiday price plus £15 administration fee)

Balance:

£ __________ (Due 8 weeks before the arrival date above)

Balance due:

   __________ (Date)