(to turn over with your payment)| Miss Mrs Mr | |
| Last Name | |
| First Name | |
| Date of birth | |
| Occupation | |
| Address | |
| Zip Code | City |
| Country | |
| Your e-mail | |
| Phone Number | Fax |
We'll arrive on between 6 and 7 p.m.
Date of departure before 10 a.m.
FIRST ROOM : Number of persons :
We would like and
Bed and Breakfast
x
€ =
€ (A)
SECOND ROOM : Number of persons :
We would like and
Bed and Breakfast
x
€ =
€ = B Options : (riding ,other..................)
€ = C
TOTAL to PAY = (A + B + C )= € = D
Which we pay a deposit of 30% in the name of C.Perrier amount (30% D) Euros
Balance 70% D = Euros
In case of payment by cheque or bank transfer :balance will be paid by cheque ( french account ) or cash on my arrival at hand over the keys.
In case of payment by credit card : ( print this booking form and send it by fax or mail )
My credit card is a : ¤ Visa ¤ Mastercard
Card's owner name Forename :
Card's number Date of expiry : Security code :
In case of payment by credit card, balance is paid at D-3
In the event of our cancelling more than 90 days before hand :10% of the TOTAL COST of the stay will be retained, less than 90 days : 30% , less than 3 days : 100%.
Cancelling insurance (optional- cost 3% - highly recommended for periods of several days - otherwise you'll be your own insurer ) : see in your country or contact : www.cabinet-t2a.com
P.S. A receipt is always provided for all payments.
Please send us this form by fax, e-mail or mail (don't forget your credit
card Nr and expiry date)
Our fax number is : + 33 (0) 4 95 77 11 37
Place date
In any case SIGNATURE ( of card's owner in case of payment by credit
card ) :