booking-form

Grassroutes Holidays Ltd

Special Interest Holidays Around The World !

BOOKING FORM 2008

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Please fill in a separate form for each person travelling

Name :

For Office Use

Address:

Postcode:

Invoice Number:

Date Booked:

Holiday Booked On:

Accommodation:

Insurance:

Confirmation Sent:

Processed By……………………………….

Signed………………………………………...

Date……………………………………………

Email Address:

Tel:

Holiday Name:

Departure Date:

Joining At:

Nights:

Room Type: (Please Tick) Single Twin Double Other

Please Tick if you are prepared to share with someone of the same sex:

Special Requirements:

Please give details of any medical problems:

Please state how and when you heard about Grassroutes Holidays Ltd:

Payment Herewith:

Deposits(s) £250.00 x persons = £

Total Enclosed £ x persons = £

Please make cheques / bank drafts payable to Grassroutes Holidays

Declaration : I declare that I, the undersigned, am authorised to sign this booking form on behalf of all the above named persons, all of whom have read the

booking conditions and agree to abide by them.

Signed : _________________________________________________ Date : ____________________

Grassroutes Holidays Ltd, 4 Beech Way, Danesmoor, Chesterfield, Derbyshire. S45 9SQ UK