Please note that this form has to be completed, signed and returned to the Cross Keys in order

for yourbooking to be secure.
(Please circle as appropriate)

Day & date of party:……………………………………………………………………………

Time of arrival:……………………………………….

Party room: THE GALLERY

No. of guests:…………………………………Occasion:……………………………………

Name of host(s):………………………………………………………………………………

Company name(if applicable):…………………………………………………………………

Email address:…………………………………………………………………………………

Contact numbers:Home:………………………………………………Work:…………………

Mobile:…………………………………………………Fax:……………………………………

Email Address:…………………………………………………………………………

NO ROOM HIRE CHARGE

Deposit: £200 (Private Rooms)

Paid: Cheque / Credit Card

Credit card name:……………………………………………

Credit card no:………………………………………Exp date:……………………

I am fully aware that you hold the right to bank my deposit in the event of cancellation

or in the event of damages caused.

Signature:……………………………………Date…………………………………

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