Questions with a  are compulsory |
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Personal information: |
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| Title |
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| Surname |
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| Date of birth |
Example:. 01-01-1900 |
| Nationality |
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| Address |
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| Postcode |
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| Town |
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| Country |
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| Telephone |
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| Mobile phone |
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| E-mail |
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Where the confirmation
will be sent to. |
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| Emergency contact |
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| Emergency telephone |
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Your holiday: |
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| Accommodation |
Cottage Oleandre |
| (Mobile homes) |
Cottage Palme |
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Cottage Pins |
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Le Mimosa |
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l'Olive |
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| Reservation for week |
evt. extra:
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| Accommodation |
La Hacienda |
| (Bungalow tent) |
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| Reserve for period: |
From:
Until:
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| Number of people |
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Names and dates of birth
of the travelers |
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(01-01-1900) |
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Extra packs
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Baby pack, a € 30 per week |
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Games pack, a € 10 per week |
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Beach pack, a € 20 per week |
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| Bicycles |
Mount.bike Man |
Amount: |
a € 50 per week |
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Mount.bike Woman |
Amount: |
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Citybike Man |
Amount: |
a € 40 per week |
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Citybike Woman |
Amount: |
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Children's bike |
Age: |
a € 25 per week |
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Children's bike |
Age: |
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Children's bike |
Age: |
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Any questions and/or special requests
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I agree to sending this information
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I have read and agree to the terms and conditions
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