La Joubertie

24380 Salon de Vergt

France

Tel No. +33 (0)5 53 35 15 19

Fax No. +33 (0)5 53 35 04 03

Email: marian.wilson@wanadoo.fr

Please complete this form and return with your deposit .

Number of people: ____

Name: ___________________________________________________

Address: ___________________________________________________

___________________________________________________

Tel No: _______________________ Email: _______________________

Please accept this form (with deposit) as confirmation of our booking for the following dates:

La Joubertie Gite: From: Saturday __________________ To: Saturday ________________

The Flexi-Gite: From: __________________ To: ________________

B&B Room: From: _____________ To: ____________ No. of Nights: _______

I enclose a cheque for: £ ______________ or Euros ______________

Please make cheques payable to: Marian Wilson

I have read and agree to the Booking Conditions for renting the above accommodation.

Signed: _____________________ Date: _________________

How did you find out about us? Please indicate as appropriate:

Our website: ¨ French Connections:¨ Owners Direct: ¨ Holiday Rentals: _______