Please complete and return with deposit / full payment to:

Mrs H Walpole, The Old Rectory, Mileham Road, Litcham, Norfolk. PE32 2NZ Tel: 07966 661175 

 

Name of Hirer_________________________________________________________

 

Address: _____________________________________________________________

 

____________________________________________________________________

 

Postcode_____________________________________________________________

 

Daytime Telephone: ____________________________________________________

 

Evening Telephone: ____________________________________________________

 

Mobile: ______________________________________________________________

 

Email: _______________________________________________________________

 

Number Adults: _______________________________________________________

 

Number of Children: ___________________________________________________

 

Dog Y/N: ______________________________________________________

 

Holiday information

Start Date: ______________________________________After 5pm

 

Finish Date: _____________________________________Before 12 Noon

 

Number of days:                Number of weeks:

 

*Please be aware weekly changeovers are on a Saturday*

 

To ensure booking please send this form back ASAP along with a cheque for either 25% of total holiday £_____________ or full payment of holiday £______________

 

Please make cheques payable to Mrs H Walpole.

 Final Payment is due 6 weeks prior to holiday start.

 

Hirer’s Signature________________________         Date______________________

Please tell us where you saw us? ________________________  

BELMONT HOUSE NORFOLK