Please complete this form in full and send it with your initial payment to :

Mrs J Smith
Hollins Farmhouse
Eskdaleside
Grosmont
Whitby
North Yorkshire
YO22 5PS

making cheques payable to Mrs J Smith.

Please telephone (01947) 895332 to check availability.

NAME AND ADDRESS
_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

POST CODE ________________________

TELEPHONE No _________________________

HOLIDAY DATE - From _______________ To ________________________

PAYMENT

Rental of Cottage £ _____________

Payment for one small pet £ _____________

Total Cost of holiday £ _____________

This Payment

Deposit £80-00 for each week £ _____________

Full Payment if booked less than eight weeks prior to arrival £ _____________

You will be provided with a booking confirmation on receipt of your initial payment,
and directions and key details prior to your arrival.

DECLARATION

I declare that I am over 21 years of age, and that I hereby accept entirely the conditions provided.
I agree to be held responsible for the balance of the payment due by the date specified.

Signature of Client ________________________ Date ____________________