Surname:            Name:

Age:            Nationality:

Address:  

City:         Postal/zip code:

Country:         E-mail:

Telephone (incl. international code):

Accommodation:

Please select your accommodation: The Stable The Granary The River Barn

Number of adults:         Number of children:

Arrival date:(d/m/yy):     Departure date (d/m/yy):

(nb. Only Saturday arrival/departure accepted in June, July and August)

Any other information you would like to give us (eg. infant equipment, maid service, extra bed):

Payment:

Currency for payment of 30% deposit: Euro GB Pounds Sterling (nb. the rent balance is payable on arrival in Euro)

Weekly rental rate (Euro):       Total Amount (Euro):

Privacy clause. I authorise Delia Poggiagliolmi of Molin del Resco to use my personal details in accordance with art. 13 of the Italian law n. 675/96, which guarantees that the information that I provide will be treated in a confidential manner:  yes    no