Name ......................................................................

Address..................................................................

...............................................................................

Post Code ............................

Telephone ..........................................

La Rouillardais

Booking Form

Date of Arrival ..............................

Date of Departure .........................

Total No. of Nights .............

Port of Arrival in France .......................................

Type of Accommodation required:
(Please tick)

Holiday Cottage rental

Bed & Breakfast

Number of persons .........

Do you require a cot ........

Please advise if you have any special needs:

.............................................................................................................................

Please enclose a deposit of £10 per night for B & B

or

£70 per week for Holiday cottage rental.

Cheques made payable to : L & D Dealtry

Total deposit sent ...................

Please return this form plus deposit within 7 days to:

L & D Dealtry
La Rouillardais
53380 Juvigné
France

Telephone: 0033 (0) 243023516