Derek’s Place

Name

Surname

Title TitleMr.Mrs.Ms.Miss

Email Address

ID / Passport

Telephone

Mobile

Physical Address Field 1

Physical Address Field 2

City or Town

Postal Code

Please Select Province Please Select ProvinceEastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern CapeOther

Date of Arrival - DD/MM/YYYY

Date of Departure - DD/MM/YYYY

No. of Adults No. of Adults012345678910111213141516

No. of Children under 8 No. of Children under 8013254679810111213141516

Indicate the Age(s) of the Child

Payment Method Payment MethodPayfast (Online Payment)Instant EFT

Transfers & Airport Shuttle Transfers & Airport Shuttle Yes No

No. of guests & Approximate date and time of arrival

Full Cleaning Service Full Cleaning Service Yes No

Full Cleaning Service OR Kitchen, Beds & Bathrooms: Date(s) of Services

Camping Cot Camping Cot Yes No

With or Without Blanket

Full Chef Service Full Chef Service Yes No

Date(s) required, Time(s), Menu Requests, Allergies and Meal preferences, Suggested budget if any, Choices of Wine, Beer and Soft Drinks

Meals Delivered Meals Delivered Yes No

Date(s) required, Menu Requests

Restaurant Reservations, Lunch Packs & Picnic baskets Restaurant Reservations, Lunch Packs & Picnic baskets Yes No

Reservation Date(s) & Time, Number of guests, Allergies and meal preferences, Approximate budget

Pre-Arrival Shopping Pre-Arrival Shopping Yes No

Beverages & Alcohol: Date(s), Time(s). Local Wine farms include Groote Post, Cloof, Darling Cellars, Ormonde

Advance fridge stocking, Wine, Beer, Spirits and Soft Drinks Advance fridge stocking, Wine, Beer, Spirits and Soft Drinks Yes No

Shopping can include fresh pastries and artisan breads, homemade jams, spreads and cheeses produced by locals, fresh veggies, free range eggs, local olive oil and wines, fish and milk OR shopping at the local SPAR

Braai Wood & Fire Wood deliveries Braai Wood & Fire Wood deliveries Yes No

Date & time required, Number of pieces

Local Tourist Experiences for Business and Leisure travellers Local Tourist Experiences for Business and Leisure travellers Yes No

Choose a Tourist Experience: Park run, Saddle and Cycle, 16 Mile Beach adventure, Schaap Island Trial, Fishing charters, Leisure Charters, !Khwa ttu 10km hike

Once off voucher code to qualify for discount (if available)

Where did you hear about us?