My Villa in Florida | Booking Form

Reference Number

Name *

Email *

Phone *

Home Address *

Apt, suite, etc.

Country

City

State

Zip code

Name of all party members and age of children at time of booking *

One name on each line.

Total Number of Guests *

Total Number of Children *

Requested First Day (Arrival) *

dd/mm/yyyy

Requested Last Day (Departure) *

dd/mm/yyyy

Additional Options

Barbecue Rent

Pool Heating

Cleaning Fee

(Note: Cleaning fee is required for stay of under 7 days)

Payment Selection

Please select a payment method in the drop down menu.

PayPal Username

(Enter your PayPal username if you choose to use Paypal)

Currency

Please read the Terms and Conditions here.

I have read and I fully accept the terms and conditions for the rental of 142 Birkdale ST (please print a copy for your records)

E-Signature

Please sign your name in the space above as acceptance of this booking

Date of E-Signature *

dd/mm/yyyy

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Booking Form