Name:
Address:
Email Address:
Phone Number:
Number of Children in Group:
Ages of Children:
Total Number in Group:
Dates Required:
Special Requirements: (Please state details)
Meal on Arrival?	Yes/No
Chambre D'Hote?	Yes/No
Veg and Egg Hamper Required?	Yes/No
Amount of Deposit Enclosed:
How did you hear about us?	Owners Direct - Yes/No  Search Engine ( i.e. Google):  Other (please specify):

A non returnable deposit of £100 for each week will be required.

Please return this form and Cheque (payable to D.J.Hosie) to:-

A.Paysse
Aussat
32170 Aux-Aussat,
The Gers.
France