Booking Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="046fd5a3.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Townhead Steading Holiday Cottages</B></FONT><B>    </B></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="047d2b03.jpg"> <div> <A HREF="index.htm" TARGET="_top" TITLE="Townhead Steading Holiday Cottages"><U><B><U>Home</U></B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="Cottages"><U><B><U>Cottages</U></B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Location"><U><B><U>Location</U></B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="Things to do"><U><B><U>Things to do</U></B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U><B><U>Contact Us</U></B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Prices"><U><B><U>Prices</U></B></U></A></div> <div> <A HREF="http://www.cottageguide.co.uk/townheadsteading/c/viewcalendars.html" TARGET="_top" TITLE="http://www.cottageguide.co.uk/townheadst"><U><B><U>Availability Calendar</U></B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="BookingTerms"><U><B><U>BookingTerms</U></B></U></A></div> <div> <A HREF="id83.htm" TARGET="_top" TITLE="Booking Request Form"><U><B><U>Booking Request Form</U></B></U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="Visitor Comments"><U><B><U>Visitor Comments</U></B></U></A></div> <div> <A HREF="id51.htm" TARGET="_top" TITLE="Picture Gallery"><U><B><U>Picture Gallery</U></B></U></A></div> <div> <IMG SRC="1f791620.png" border=0 width="145" height="98" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Booking Request Form</I></div> <bR> <div> <B>If you would like to request availability for a specific period or confirm a booking subject to availability , then please complete the following form:</B></div> <bR> <bR> <bR> <div> <B> <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Title,First Name,LastName,Address 1,Address 2,Address 3,City,Country,Post Code/ ZIP,Phone,e-mail,Cottage Name,Arrival Date,Departure Date,Number of Guests,Special Requirements,I wish to confirm this booking"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A new request form was submitted"><input type="hidden" name="tlx_EmailTo" value="townhead.steading@btopenworld.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Title (Mr,Mrs, Ms., other):<br> <input type="text" name="Title" size="4" maxlength="4"></td> </tr> <tr> <td align="left">First Name:<br> <input type="text" name="First Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address:<br> <input type="text" name="Address 1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">:<br> <input type="text" name="Address 2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">:<br> <input type="text" name="Address 3" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Country:<br> <input type="text" name="Country" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Post Code/ ZIP:<br> <input type="text" name="Post Code/ ZIP" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Phone:<br> <input type="text" name="Phone" size="30" maxlength="30"></td> </tr> <tr> <td align="left">e-mail:<br> <input type="text" name="e-mail" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Cottage Name (Granary or Stable):<br> <input type="text" name="Cottage Name" size="7" maxlength="7"></td> </tr> <tr> <td align="left">Arrival Date (dd/mm/yy):<br> <input type="text" name="Arrival Date" size="8" maxlength="8"></td> </tr> <tr> <td align="left">Departure date dd/mm/yy:<br> <input type="text" name="Departure Date" size="8" maxlength="8"></td> </tr> <tr> <td align="left">Number of Guests:<br> <input type="text" name="Number of Guests" size="1" maxlength="1"></td> </tr> <tr> <td align="left">Any special requirements e.g. cots:<br> <textarea name="Special Requirements" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="left">I wish to confirm this booking(Y/N):<br> <input type="text" name="I wish to confirm this booking" size="1" maxlength="1"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </B></div> </td> </tr></table></body>