CLICK HERE TO PRINT THIS BOOKING FORM THEN FAX TO +62 361 84 75 943 |
Name of Villa : VILLA BALADEWA BALI ( 3 ) Bali - Indonesia. Check in date: / / Flight Number Arrives : hrs. Check out date: / / Flight Number Departs : hrs. Total number: Adults: Children: Total number of nights required: Rental Fee: US$ per night. Minimum Deposit 50% US$ Balance US$ If you have any special requests such as a meal upon arrival, a list of groceries you need (including wines or beers) or to reserve tours or activities then please include these on a separate fax or e-mail. I/we hereby apply for the aforementioned Villa on the dates specified above and I/we authorize payments to be charged to the credit card specified hereunder in accordance with Indovillas terms and conditions as payment for accommodation on Bali. Signed: Print Name: e-mail address: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 accommodation in Bali. 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 CC statements go to)
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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. |