THE BIRCHES FAX BOOKING FORM

Please print out this faxable form, and complete the details as required
and fax it to The Birches. Fax Number +44 (0)15394 48921

Name

:

Address

:

Street

:

City

:

County

:

Country

:

Post Code

:

Telephone

:

Arrival

dd/month/yy               /            /

Departure

dd/month/yy               /            /

No. of Guests

 Adults[      ]     Children[      ]

Bedoom Required

 Eleanor[  ]      Guinevere[  ]

Special Requirements

:

 Comments

:

Cheque

:

Credit card type

 Access[  ]  Visa[  ]  Mastercard[   ]  Switch[  ]

Credit Card No.

:

Expiry Date

:

Name on Card

:

Thank you