Please print this form, complete, and return to the address below with payment.

From (print full name):  .....................................................................................................

Address:    ............................................................................................................................

...............................................................................................................................................

Telephone number: ............................................................................................................

Mobile number: ..................................................................................................................

E-mail address:  ..................................................................................................................

Number of nights required: ...............................................................................................

Arrival date: .............................................  Date of departure: ..........................................

State preference for twin beds or double...........................................................................

I enclose my  *cheque for  £ ...................... as a  **deposit/in full payment  (delete where applicable)  in respect of the above dates to be reserved for two Guests in the names of:

(i)  .........................................................................................................................................

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(ii) .........................................................................................................................................

Car registration no:   ...........................................................................................................

I have read and agree to abide by the booking terms and conditions:

Signed:   .............................................................  Date:  .....................................................

 *Cheques should be made payable to Patricia Burrows and sent by return to

Alfred Place, Ware Lane, LYME REGIS, Dorset, DT7 3EL .

A reservation made by telephone or e-mail will be held provisionally for 5 days only.

**Balance of payment is due no later than eight weeks before commencement date or

in full if booking is made within eight weeks of commencement date. 

Please see full Terms and Conditions.