Burgundy (France) - La Maison de la Vieille Vigne

Booking Form for
"La Maison de la Vieille Vigne"

If you have any questions or doubts about how to fill it out, please contact us for assistance

Please fill out this page - you can do this directly on the screen

Print_it

Send it along with your deposit cheque - see mailing instructions below

Please note that we will be unable to process your reservation without receiving BOTH the completed signed booking form and deposit.

First Name:
Last Name:

Address:

City / Town:

Province/State:
ZIP Code:
Country:

Phone:
Fax:
Mobile:
Email:

Arrival Date:	(e.g. May 1st, 2007)
Departure Date:	(e.g. May 15, 2007

Comments:	Please include here any specific requests or additional comments. Also tell us how you heard about La Maison de la Vieille Vigne.

The House will be occupied by people:

Name	Age	Email
1.
2.

We can provide a high speed internet connection for those clients bringing their own computers.

Will you be requiring an internet connection? YES NO

We can provide some assistance in regards to the planning of activities during your stay - French lessons, wine or cooking classes, walking tours, etc.

Would you potentially be interested in having us help you plan some activities during your stay in Burgundy? YES NO

Cancellation Policy- Our cancellation policy is as follows:

The 50% of the total rent payable reservation deposit (per reserved week) remains non-refundable at all times, unless we are able to rent out the cancelled period to other clients, but if we receive written notice of cancellation more than 30 days before the date of arrival, you will owe us no further outstanding balance.

There will be no refund of the balance if cancellation is made by written notice or otherwise 30 days or less before the date of arrival unless we are able to rent the house for this period, which we will make every effort to do.

Herewith I declare my booking. In doing so I acknowledge that I understand and agree to the cancellation policy and the house rules.

I also agree to send a 200.00 EUROS damage deposit along with my final payment.

I agree to pay for the utilities (water/electricity/phone) consumed during my stay.

I agree to leave 40.00 Euros at the house for the cleaning crew upon departure.

Date:

Signature:

Please note that we will be unable to process your reservation without receiving BOTH the completed signed booking form and the cheque.

PLEASE MAKE CHEQUE PAYABLE TO:

FORT REALTY LTD.

- Payment via wire transfer can be arranged on request -

For payments in
US or CANADIAN DOLLARS

Please send this page along with your deposit cheque to:

FORT REALTY LTD.
814 Broughton Street
Victoria, B.C., V8W 1E4
CANADA

For payments in
EUROS

Please send this page along with your deposit cheque to:

FORT REALTY LTD.
1, Rue des Chaumes
21700 Villers-La-Faye
FRANCE