DORDOGNE BOOKING FORM Important! - Please read the paragraph below
It is very important that an Availability Request is made before sending the Booking Form. Availability can also be checked telephone or fax. Although you can complete this form on screen we will only accept a completed and signed Booking Form sent to us by fax or post. Please read the Booking Conditions carefully.	Simply Perigord SARL Place de la Farge 24260 Le Bugue, France Tel: +33 (0) 5 53 54 54 31 Fax: +33 (0) 5 53 54 11 01

Title / Initials / Surname Address Telephone etc Home Work Mobile Fax Email Other Members of the party (Title & Surname) Property 1:- House Ref Arrival Date Departure Date Property 2 - House Ref Arrival Date Departure Date How did you hear of us:- Internet, recommended ? Linen If ordering linen or linen is included in the rental price please specify your needs taking into account the bedroom arrangements of the house Double beds X Single beds X Other Services Required ie 'Final Day Cleaning' etc (see About Our Houses) Initial Payment A full statement of account detailing the rental costs, security deposit etc. will be sent upon receipt of the completed Booking Form and Initial Payment. If booking within 9 weeks of the start of the holiday, the full payment is due at the time of booking. INITIAL PAYMENT (Euros) 25% of House Rental Costs Payment by Credit Card If you would like to pay your Initial Payment (or Full Payment if booking within 9 weeks of the start of your holiday) by VISA or MASTERCARD please complete this section. 1% card surcharge applies. I authorise Simply Perigord to charge my account with the *Initial/Full Payment amount + 1% card surcharge* delete as necessary Credit card Number 3-digit security code (see reverse of card) Expiry date of card Cardholder's Name Signature Cardholder's Address Payment by BANK to BANK transfer We will accept payment by BANK to BANK transfer in EUROS ONLY. Please contact us for our full bank details. Please request that Bank Charges for the transfer are for your account. Any charges incured by us for the transfer will be added to your final balance.

I declare that I am over 18 years of age and agree that this booking is made in accordance with the Booking Conditions that I have read. I agree to be held responsible for the balance of the hire in accordance with the Booking Conditions. Date...................................................... Signature.....................................................

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