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CRUISE BOOKING FORM & CREDIT CARD PAYMENT AUTHORITY
 
Name of Vessel/Ship:                                                                                                                 

Cruise date, From:             /           /            Until:             /           /           Code:                         

Total number of berths required:                 Total guests: Adults F;                Children                 

Amount payable per passenger US$                   Total amount payable US$                             

A minimum deposit of 30% is required in order to secure this booking and the balance due 
sixty days prior to arrival.

I/we hereby apply for the aforementioned cruise on the dates specified above and I/we authorize payment to be charged to the credit card specified hereunder in accordance with Indovillas terms and conditions as payment for the above cruise.

Signed:                                                                                                                                 

Print Name:                                                         e-mail:                                                             

Telephone: Home                                                  Work/Mobile:                                                

Credit Card Payment in favor of PT. Indovillas Bali - I hereby authorize the payment of US$                     be converted to Rp.                              (Indonesian Rupiah), and charged to my credit card as payment for the aforementioned Cruise.

Card Type: Visa* / MasterCard* (*Delete as applicable)

Card Number:                                                                                                                                   

Expiry date:             /           /              Approval Code (for bank use only):                                       

Last 3 digits in signature section on back of card (if any):                                                                

MasterCard ICA Number or Visa 4 digits:                                         (MC - back of card, usually bottom right corner - Visa 4 digits on front below CC No.)

Name of issuing bank:                                                                                                                     

Cardholders Name:                                                              Date of Birth:             /           /             

Cardholders Signature:                                                                                                                   

Passport number:                       Expiry date:           /         /            Nationality:                              

Billing Address (where the credit card statements go to):                                                               

                                                                                                                                                        

Thank you for booking with Indovillas. Remember to fax the completed form to +62 361 84 75 943.
Once your credit card has been approved your confirmation voucher will be issued.