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Inquiry & Reservation Form:
(no credit card necessary at this point)

Name :

E-Mail-Address :

retype Your E-Mail-Adress :

Hotel Reservation:

Name of Hotel :

Tourist or Hotel Area :

Room Type :

Check in Date :

Check out Date :

How many Nights ? :

How many Adults per Room ? :

How many Children per Room ? :

Ages of children:

Require Extra Bed ? :

Yes No

Special Request :

If possible:

Non-Smoking	Smoking
Low Floor	High Floor
Twin Beds	King Bed
Connecting Rooms	Adjoining Rooms

Please note that your special requests are subject to each individual hotel's availability, and cannot be guaranted.

Travel Information:

Arrival Date :

(Day / Montth / Year)

Arrival Time :

(Local Time in Bali)

Airline / Flight No. :

Require Airport transfer ? :

Yes No (extra charges may apply)

Details of Identity:

Salutation :

Mr. Mrs Mss Dr

Family Name :

Surname:

Date of Birth :

(Day / Montth / Year)

Nationality :

Address :

City :

State / Province :

Postal Code :

Country :

Home Phone :

Handphone:

Office Phone :

Fax :

Before clicking the submit button ......

Please note: when you press the "Send Button" that you agree with the: TERMS & CONDITIONS

Your reservation will be confirmed as soon as possible.

Please type this security code [ 7654 ] here:

Please Note that we do not hold any reservation for You until we have a full or deposit payment.