Name & Address Please print name & Address if incorrect                                                                                                                                                                                   Car Reg (                                                 ) Please include E-mail address Parking permit No

          Your Phone Number (Please include STD No)

Home

Emergency contact number / Mobile

Week No

Arrival Date

Vacate Date

No Nights stay

         Your Party

Adults
Teenagers (12 to17 )
Children ( 3 to 12 )
Infants

          Your Holiday Payments

Short Breaks ( 5 Nights ) (recommend you order a on-street car parking Permit)	£
Full Week ( 7 Nights ) (1 Free on-street car parking permit)	£
Two Weeks ( 14 Nights ) (2 Free on-street car parking permit)	£
Cot if Required No Linen supplied
Key Deposit (returned to you after 14 days of vacating)	£30.00

Via Pay-pal there is a 5% Service surcharge

£

Discount for last Minute offer

Total Grand Balance	£
Deposit to be Paid A.S.A.P	£
Total Balance to be paid	£

        DECLARATION

          I have accepted the Term & Conditions of hire and I am 18 and agree to be held responsible for the balance of hire for the property Duo in accordance with the booking                        conditions and to be responsible for any damages that may occur.

      No smoking or pets aloud

I agree to pay the Full Balance Duo 8 Weeks before Arrival Date

Signature :

Date

           Cheques to be made payable to Mr J W Hilton

           By invoice via a Pay-Pal Account By request

           or Bank Transfer with arrangements by Mr J W Hilton

           Please return to, Mr James William Hilton Grange Cottage, 6 Kendal Drive, Bolton on Dearne, Rotherham, S63 8NJ