12 Park Street Booking Form

Please confirm your booking by E mail or telephone, print this page when it is completed and send it with your £100 deposit to the address below. Cheques should be made payable to 'West Wales Cottages' and sent to:

West Wales Cottages,
Motygido Farmhouse,
Llanarth, Ceredigion. SA47 0NU
Telephone

You can fill in the details on your computer before printing - (However if you do not have a printer, please email or post to us the holiday dates required, your name, address, telephone number (and email if you have one) and the names of your group, with the ages of those under 18.

Name of person making the booking.

Postal Address including Post Code

Telephone Number

Mobile Number
Email Address

Arrival Date

Leaving Date

Names of all persons in your party, Ages if they are under 18
1.	5.
2.	6.
3.	7.
4.	8.

Total Cost of holiday

Tick box if receipt by post is preferred OR

Tick box if receipt by Email is preferred

I am over 21 and have read and agree to the Terms and Conditions and
disclaimer for renting 12 Park Street.

Signed

Date

If you have filled in your email address, your receipt will be sent in an email
and as an attached document that you can print.