BOOKING FORM

Re: Vilcabamba, 5 Bell Hill Park , Lindale , Near Grange. LA11 6JZ

Please complete the following :

1) Your name

Your address

Your telephone number - home:

- mobile

Your email address

2) Total number of adults

Total number of children

Cot required ? Yes / No

3) Date of arrival

Date of departure

Total number of nights

4) Amount of payment enclosed

5) Signed Date .

6) From which source did you find details of this accommodation?

Mrs B Gibbons

17 Newhaven Close

Bury

Lancs

BL8 1XX

Tel 0161 797 0804 Mobile 07765 166246