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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML>
<head>
<title>Eurocottage Ltd, Castlebar enquiry/booking form</title>
<LINK REL="STYLESHEET" HREF="http://www.castlebar.ie/styles/accomstyle.css" CHARSET="ISO-8859-1" TYPE="text/css">
</head>
<body bgcolor=#ECFFEC>
<div align="center"><table>
<tr>
<td><div align="center"><b><font size="+3" color="#008000">Eurocottage Booking
or Enquiry Form</font></b></div></td>
</tr>
</table>
</div>
<hr>
<FORM action="http://www.castlebar.ie/cgi-bin/formhandlercgi/120307_fm.pl" method="get">
<input type="hidden" name="recipient" value="mansgeerinck@hotmail.com">
<div align="center">
<H4></h4>
<TABLE BORDER=0 CELLSPACING=1 WIDTH=500>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<font color="#000080"><b>Personal Details</b></font>
</TD><TD VALIGN=top WIDTH=300>
</TD></TR>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<P ALIGN=RIGHT><font color="#008000">Name </font>
</TD><TD VALIGN=top WIDTH=300>
<P><INPUT TYPE="text" NAME="Name" SIZE=40>
</TD></TR>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<P ALIGN=RIGHT><font color="#008000">E-mail: </font>
</TD><TD VALIGN=top WIDTH=300>
<P><INPUT TYPE="text" NAME="Email" SIZE=40>
</TD></TR>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<P ALIGN=RIGHT><font color="#008000">Address </font>
</TD><TD VALIGN=top WIDTH=300>
<P>
<INPUT TYPE="text" NAME="Address1" SIZE=40><BR>
<INPUT TYPE="text" NAME="Address2" SIZE=40><BR>
<INPUT TYPE="text" NAME="Address3" SIZE=40><BR>
<INPUT TYPE="text" NAME="Address4" SIZE=40>
</TD></TR>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<P ALIGN=RIGHT><font color="#008000">Telephone: </font>
</TD><TD VALIGN=top WIDTH=300>
<P><INPUT TYPE="text" NAME="Telephone" SIZE=40>
</TD></TR>
<TR>
<TD VALIGN=top align="left" WIDTH=200>
<P align="right">
<font color="#008000">I wish to make:</font>
</TD><TD VALIGN=top WIDTH=300>
<font color="#008000"><SELECT NAME="EnquiryOrBooking">
<OPTION SELECTED>an enquiry
<OPTION>a booking
</SELECT></font>
</TD></TR>
</TABLE><TABLE BORDER=0 CELLSPACING=1
WIDTH=498 height="259">
<TR>
<TD COLSPAN=2 WIDTH=498 height="57">
<P ALIGN=left>
<P ALIGN=left><b><font color="#000080">Duration:</font></b>
</TD></TR>
<TR>
<TD WIDTH=147 align="right" height="22">
<P ALIGN=RIGHT><font color="#008000">Arrival Date: </font>
</TD><TD WIDTH=351 height="22">
<P><font color="#008000"><SELECT NAME="ArrivalMonth">
<OPTION SELECTED>January
<OPTION>February
<OPTION>March
<OPTION>April
<OPTION>May
<OPTION>June
<OPTION>July
<OPTION>August
<OPTION>September
<OPTION>October
<OPTION>November
<OPTION>December
</SELECT> Day <INPUT TYPE="text" NAME="ArrivalDay" VALUE="?" SIZE=2 MAXLENGTH=2>
Year <!--webbot bot="Validation"
B-Value-Required="TRUE" --><SELECT NAME="ArrivalYear" size="1">
<option>2015</option>
<option>2016</option>
<option>2017</option>
</SELECT>
</font>
</TD></TR>
<TR>
<TD WIDTH=147 align="right" height="25">
<P ALIGN=RIGHT><font color="#008000">Departure Date: </font>
</TD><TD WIDTH=351 height="25">
<P><font color="#008000"><SELECT NAME="DepartureMonth">
<OPTION SELECTED>January
<OPTION>February
<OPTION>March
<OPTION>April
<OPTION>May
<OPTION>June
<OPTION>July
<OPTION>August
<OPTION>September
<OPTION>October
<OPTION>November
<OPTION>December
</SELECT> Day <INPUT TYPE="text" NAME="DepartureDate" VALUE="?" SIZE=2 MAXLENGTH=2>
Year <SELECT NAME="DepartureYear" size="1">
<option>2015</option>
<option>2016</option>
<option>2017</option>
</SELECT>
</font>
</TD></TR>
<TR>
<TD COLSPAN=2 WIDTH=498 height="57">
<p><font color="#000080"><b>Accomodation Required:</b></font>
</TD></TR>
<TR>
<TD WIDTH=196 align="right" height="25">
<P align="right"><font color="#008000">Accomodation Type
:</font>
</TD>
<TD WIDTH=302 height="25">
<font color="#008000"> <SELECT NAME="AccomType1" size="1">
<option>Cottage 2 Bedroom</option>
<option>House 3 Bedroom</option>
<option>Cottage & House</option>
</SELECT></font>
</TD></TR>
<TR>
<TD WIDTH=196 align="right" height="25">
<p align="right"><font color="#008000">Number of people: </font>
</TD>
<TD WIDTH=302 height="25">
<font color="#008000"><INPUT TYPE="text" NAME="NumAdultsAccom1" VALUE="?" SIZE=2 MAXLENGTH=2>
<!--<font color="#D31A14">Number of Children</font> <INPUT TYPE="text" NAME="NumChildrenRoom1" VALUE="?" SIZE=2 MAXLENGTH=2></P>-->
</font>
</TD></TR>
</TABLE>
<P> </P>
<P><font color="#008000">Please write any request or further enquiries you
may have: -</font></P>
<P><CENTER><TEXTAREA NAME="RequestFurtherInfo" ROWS=13
COLS=57></TEXTAREA></CENTER></P>
<P><CENTER>
<font size="3">
<INPUT TYPE="submit" NAME="Submit" VALUE="Submit">
<INPUT TYPE="hidden" NAME="sort" VALUE="order:Name,Address1,Address2,Address3,Address4,Email,Telephone,EnquiryorBooking,ArrivalYear,ArrivalMonth,ArrivalDay,DepartureYear,DepartureMonth,DepartureDate,RoomType1,AccomType1,NumAdultsAccom1,AccomType2,NumAdultsAccom2,RequestFurtherInfo">
<INPUT TYPE="reset" VALUE="Start over">
</font>
</CENTER></P>
<P> </P>
<div align="center"><a href="http://www.eurocottage.ie/"><font color="#008000">Back to Eurocottage Main Page</font></a></div><div align="center"><!--<a href="http://www.castlebar.ie">Visit the local towns Web page</a>--></div>
</div>
</FORM>
</BODY>
</HTML>