La Grange du Moulin Booking Form
First Name
Primary Address

Home Telephone
Accomodation required
Date of arrival
[4pm onwards]
/ /  
Date of Departure
[by 10am]
/ /  
Number of Adults

Number of Children (under 16)


Names of Adults and Names and Ages of Children

  Total Rental Deposit

Extras Required

Personal Towel Hire (£8/pp)

Pool Towel Hire (£8/pp)

End of stay Cleaning (£35 or £50 peche)

Notes /requests
search terms used ?

I have read the Terms and Conditions and I accept them on behalf of all my party who will be staying in the property and on whose behalf  I am authorised to enter into this agreement. I have read all the information available regarding the property. I am over 18 years of age.


  Submission acts as Signature