REGISTRATION In order to help us prepare your stay, please fill in the form below.If you have any questions, please do not hesitate to contact us. Name of lead guest*ForenameSurname I confirm that I am over 18.*YesNo Total number of guests*12 Name of second guest*ForenameSurname I confirm that all guests are at least 14 years of age.*YesNo Please confirm the ages of the guests under 14 - we will contact you to discuss this.* Address* Line 1 Line 2 Postcode AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Mobile phone* Email address* Are you bringing bicycles? *YesNo Are they electric?*YesNo Number of bicycles (there is no charge, it is just so we can ensure enough storage space !)*12 We can provide all of our information in either English or French, please select your preference:*EnglishFrenchClick HERE to read our Terms of Rental I confirm that I have read and agreed to the terms of rental and confirm if any of these are breached then deductions may be made from my deposit and I may be asked to leave early without refund.*Yes How did you hear about us?*Please Select Personal recommendationWe've been before!Booking.comAbritelAirBnBCheque VacancesFacebook groupFrance VoyageFreewheeling FranceGites.euGolightlyGoogle searchHome AwayInstagramLuberon.frPerfectly ProvenceRide & RestTheLuberon.comTourist Office Other Finally, we would love to know why you are coming to Apt? Please let us know if you have any questions.SubmitReset
