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Cards Accepted
Card Details Form

Credit/Debit Card Details
Customer Not Present

Please PRINT this form and complete by hand in CAPITAL LETTERS
Please do not email your card details from this website.
Post to Marilyn and Bob Downes, Box Hedge Farm B&B, Coalpit Heath, Bristol, BS36 2UW.

Name and Initials of Cardholder:

Address of Cardholder:

What Card:
(e.g. MasterCard, Visa etc)

Card Number:

Card Issue Number:
(For Switch and Solo Cards only)

Card Expiry Date (MMYY):

Card Security Number:
(Last 3 digits on signature strip on back of card)

Cardholder telephone contact number:

Please note that deposits are non-refundable and that accommodation is provided subject to our Terms and Conditions.

Cardholder Signature: .............................................................

Date:  ..............................................

Name and Address of the persons the accommodation is reserved for
if not the cardholder: