Booking Form

Personal Details

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Postcode or zip code

Country

Home Telephone

Mobile Telephone

Holiday Details

Please use a separate booking form for each cottage

Cottage

Arrival Date

Departure Date

Bookings are from 4.00pm on the arrival date to 10.00am on the day of departure.

Please indicate likely time of arrival

How did you hear about Peyloubere?

Baby/Toddler equipment required

Other Requirements

Names of others in your party

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Payment Details

Total cost of holiday €

Booking Deposit (20%) €

Deposit is being paid by

By credit card - MasterCard, Visa or Carte Bleu. Please advise card number, expiry date and three digit security code. We suggest that this information is conveyed to us by telephone or by way of two separate Emails.
By cheque - if you wish to pay by Euro cheque please make the cheque payable to 'Theresa Martin'

All cheques should be sent to Theresa Martin at Domaine de Peyloubere, 32550 Pavie, France

By bank transfer - please request bank details

We regret that deposits are non-returnable. Please ensure that you have health and holiday insurance at the time of booking, which should include loss of deposit through cancellation.

By submitting this form you declare, on behalf of the persons named above, that you have read and agree to the Self Catering Booking Conditions and agree to pay the balance of the cost of the holiday, together with a damage deposit of €200, at least six weeks prior to the start of the holiday.