Request for Reservation

Very important : This form is an application for reservation. This booking will be confirmed after you return the contract we will send you by mail. Please fill in all the spaces so we can register you application the best we can. Thank you.

Full Name:
Addrese :
Zip Code :	City :
Country :	State :
Phone :
Fax :
E-mail :

Dates of Stay

Arrival
Departure
Number of night(s)
Number of person(s)
Type of Rental	Rental : Selected Coquelicots Lilas Tournesols Azur

Remarks