fax booking

Please follow the steps below to ensure that we get everything that is needed for a successul booking. If you have any problems Contact Us. Once completed please PRINT out and FAX to +64 3 752 0608

(Bold required)

Your name Your e-mail   Email addresses must be included and correct to receive a response   Quotation Number Q- (if applicable)   Address City Address2 Country State Zip Phone Fax

accommodation adults children infant(s)   Perivale Farm Cottage 01 02 03 04 05 06 01 02 03 04 05 06 01 02 03 04 05 06 Require Cot Highchair

Please select your estimated time of arrival

Time of Arrival 12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM We require a car park

Check in Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) Year 2008 2009 2010 2011 2012 2013 2014 2015 Check out Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) Year 2008 2009 2010 2011 2012 2013 2014 2015

Comments, Enquiries and Special Requests

Credit card details are required to confirm bookings

Name On Card

Credit Card Type Visa Mastercard

Credit Card Number

Expiry Month / Year Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) / 2008 2009 2010 2011 2012 2013 2014 2015

CVV2

What is a CVV2 code? The CVV2 is a 3 or 4 digit code embossed or imprinted on the reverse side of Visa or MasterCard