|
For further inquiry
& reservation, please fill-in the form below and submit to
us.
|
Personal
Detail |
| Full
Name : |
|
| Email
address : |
|
| Address
: |
|
| Country
: |
|
| Phone
: |
Fax
|
Reservation
Detail |
| Inquiry
: |
|
| Check
in date : |
Flight no.
Time
|
|
dd/mm/yy |
| Check-out
Date : |
Flight No.
Time
|
| No.
of pax required : |
Adult
Child
Infant |
|
Pax name : |
1st
2nd |
|
3rd
4th |
|
5th
6th |
| No.
of room required : |
Single
Double
Triple
Ext. Bed |
|
|
| Discovery
Holidays : |
|
|
|
| Hotels
and Tours : |
Hotels |
|
|
|
Tours |
|
|
|
|
|
|
|
Transfer
rates |
|
|
|
|
|
|
|
|
| Hotel
requested : |
|
| Account: |
For Bank Transfer Payment,
our Bank Account:
PT. Bank Negara Indonesia - Denpasar Branch
Jalan Gajah Mada 30
Denpasar, Bali - Indonesia
Account Number: 013320.002 PT. WaliBali Citra Adiwisata
Swift Code: BNINIDJA |
|
Other
Comment/Information
|
| |
|
|
|
