Norfolk Cottages 

Malthouse Farm, Malthouse Lane, Gissing, Diss, Norfolk. IP22 5UT 

Tel: 01379 658021                Fax: 01379 651170 

E-mail: bookings@norfolkcottages.net         Website: www.norfolkcottages.net 

Booking Form 

Please complete both pages of this form and be sure to sign the reverse, and then return the form with your deposit to Norfolk Cottages. Thank you!  

Rose Cottage

   

Honeysuckle
Cottage  

   

Primrose Cottage

   

Bluebell Cottage

   


Arrive:    Depart:   No. of nights:    Price:   

Company Name (if applicable) 

Name:  

Address:   

Postcode:                    Tel:                                 Mobile:                            Email:  

Your party: Please enter names of all your party and the ages of persons under 18.   

Please let us know if a member of your party is celebrating a Birthday or Anniversary.
  Title   Name   Surname   Age  -U18’s 
1        
2        
3        
4        
5        
6        
7        
8        
9        
10        
11        
12        
13        
14        
15        
16        
17        
18        
19        
20        
21        
Assistance dog     Pet dog  

Additional Equipment: No. PleaseReserve
Shower chair (wheeled) 2  
Shower chair (no wheels) 1  
Raised toilet seat 2  
Over bed monkey pole 1  
Blox chair raisers 1  
Blox Bed raisers 1  
Over bed table 1  
Wheeled walking frame. 1  
High Chair 2  
Cot (please bring your own bedding) 2  
Commode chair 1  
Electric Riser Recliner Chair
£5 per night		 1  
Oxford Mini 140 Mobile Hoist (battery powered) £7 per night 1  
Just for use by Norfolk Cottages…  please tick

Can we send details of our special offers…
By post?
By email?
What is the reason for your visit?

Holiday

Family/Friends get-together?

Birthday/Anniversary
Other

PAYMENT SUMMARY:

Cost of  cottage/s 

£ 

Dog £20 

£ 

Security Deposit (Booking condition no. 7) 

£ 100/200 

Rental of Riser Recliner Chair @ £5 per night 

£ 

Rental Oxford Mini 140 Mobile Hoist @ £7 per night £ 

Total Cost of Holiday 

£ 

Deposit 25% / Full amount enclosed (Booking condition no. 2) 

£ 

 

I declare that I am over 18 years of age and agree that this booking is made in accordance with the Booking conditions.   
We recommend taking out cancellation insurance to the value of your holiday.   

HIRER’S SIGNATURE: 

DATE: 


Payment details: Cheques (please make payable to Anglo Euro Properties Ltd.)  Visa,Mastercard,Delta, Solo, Switch.  2% charge for credit cards. No charge for debit cards (Booking condition no. 2)   

Card number: 

Expiry date: 

  

Cardholder Signature: 

Issue number: 

  

Please return form to;   

Norfolk Cottages Booking Office
17 Owen  Road, Diss, Norfolk  IP22 4ER

Booking condition

ORDER YOUR HOLIDAY GROCERIES