Palmboom (Jacobsbaai)

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

Confirm if you will be bringing pets? Confirm if you will be bringing pets?YesNo

Indicate the Number of Pets

Full Cleaning Service Full Cleaning Service Yes No

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

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

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

Where did you hear about us?