Dairy Cottage
Booking Form by MAIL

Please PRINT this form then fill in
the details and MAIL it to:
Low Graythwaite Hall,
Graythwaite,
Nr Hawkshead,
Cumbria, LA12 8AZ

Tel: 015395 31676

Please fill in the details then MAIL it to:
Low Graythwaite Hall,
Graythwaite,
Nr Hawkshead,
Cumbria, LA12 8AZ

Tel: 015395 31676

 Payment details:
Please make cheques payable to
'Dairy Cottage' and drawn on a UK bank. If paying by Credit/Debit Card please fill in your details at the bottom of this form. Thank You.
Your Details
Name_______________________________________________________
Address_____________________________________________________
____________________________________________________________
_____________________________________________Postcode__________________
E-Mail Address_____________________________________
Telephone - Daytime____________________Evening_____________________
Your Holiday Details
Holiday dates required - From_______________ To ___________________
Number in your party - Adults_____________ Children_____________
I have read and agree to the Terms & Conditions [     ]  
I am over 18 years old [     ]
Deposit 50% of the rental (or Total if within 8 weeks) £__________
Pets (£20 per pet per week) £__________
Please add 2% if paying by credit/debit card £__________
TOTAL AMOUNT £__________
Please supply a cot [    ] highchair [   ]  

Signed_______________________________ Date__________________________

Credit Card Details
Type of card_______________________
Card number_______________________
Security number_______________________
Valid from date - Month__________ Year___________
Expiry date - Month__________ Year___________
Issue no. (Switch only)_________
Name on the card____________________________
Address of card holder (if different from above)____________________________
_________________________________________________________________
___________________________________________ Postcode_______________