BOOKING FORM CHEZ DEUX BALCONS 3 RUE FONT BASSE ST. JEAN DE LA BLAQUIERE, FRANCE NAME OF PERSON MAKING BOOKING:________________________________ HOME ADDRESS:________________________________ E-MAIL ADDRESS:________________________________ TELEPHONE NUMBERS:_____________________(home) _____________________(work) FAX NUMBER:________________________________ NAMES OF ALL MEMBERS OF PARTY: (include age if under 18 years of age) DATES REQUESTED: FROM: SAT______________ TO: SAT______________ (ARRIVAL TIME: after 4:00 pm DEPARTURE TIME: 10:00 am) FOR BOOKINGS RECEIVED LESS THAN EIGHT WEEKS PRIOR TO ARRIVAL DATE, PAYMENT IN FULL IS REQUIRED TO CONFIRM YOUR BOOKING. DEPOSIT DUE WITHIN 7 DAYS OF BOOKING: $250.00 (Refundable deposit is to confirm booking and provide a security deposit) COST OF ACCOMODATIONS PER WEEK: $__________ TOTAL COST OF ACCOMODATIONS: $__________ (Due no less than 8 weeks before arrival) AMOUNT ENCLOSED: $__________ The booking conditions, general information, and above particulars have been read and accepted by me on behalf of all persons included on this form by whom I am duly authorized to make this booking. Signed Read and Approved:____________________________ Date:______________ (I am over 18 years of age)