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        GLEBE COTTAGE                 EL PATIO

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Please print off, fill in and return with Good Will Deposit of £50.00

 Date of Arrival           Day                   Date                Month                  Year

 Date of Leaving        Day                   Date                Month                  Year

 Duration of stay        1 WK                 2 wk                W/end                  other (state)

Rate for above stay    £                         Sterling/                                Euro          

Number of occupants  1 /2 / 3 / 4 / or more (please state)                            any babies      

Your Details   (please print clearly)

 First name/s  __________________Surname __________________________

 First line or address ________________________________________________

 Second line of address   _____________________________________________

 Town / City _______________________________________________________ 

 Postcode _____________________ Country  ____________________________

 Home phone number (inc code) ________________Mob ___________________

 Email address  _____________________________________________________

 How did you hear about El Patio Website  /  holiday brochure  /  recommended by friend  /  other

 I am over 18 years of age        (tick if appropriate) I agree to the booking terms           (tick if appropriate)

 Method of payment:  cheque / visa  /  direct transfer: Please send your deposit with this form completed to:

Marie Stitt

67 Hartswood

 CRUMLIN

 BT29 4PY

Within 7 days from postmark.

Thank you for your booking and we will send you confirmation and a receipt.