Your Names:

 

Address & postcode:

 

 

Tel:                                                                       Mobile:

Number of Adults:  [      ]    Number of Dogs:  [      ]

Subject to availability, please reserve a lodge
from 4.00PM on (date)                                to 10.00AM on (date)

Double bed:  [      ]    Twin Beds:  [      ]    Either: [      ]

Towel Hire:  Number of towel sets required  [      ]

I wish to pay by:  Credit card  [   ]    Debit card  [   ]    Cheque  [   ]    Postal order  [   ]

(if applicable) Card number:

Name on card:

Valid from:            /              Expiry:            /                Issue number (Maestro/Solo):

Last 3 digits from signature strip (all cards):

I authorise you to debit my card with the amount of £
OR
I enclose a cheque/postal orders for £

Please make cheques payable to BURNBANK LODGES

Signature: