Bali Romantic Hotels - Hotel Reservation and Travel Service

Name:	*
E-Mail Address :	*
retype Your E-Mail Address

I would like to :	*
Require airport transfer? :	Yes No
Arrival date:	Day/Month/Year
Arrival time :	local Bali Time
Flight No. :	Airline :
Name of the Hotel :
Hotel or Tourist Area :
Room Type :
How many room(s) :
Require Extra Bed :	Yes No
Check in date :	(dd/mm/yy)
Check out date :	(dd/mm/yy)
How many adults per room :
How many children per room :
Special Request :

Details of Tour or Travel Programm:
Name of the Tour :
Tour Code :
How many Adults :
Day of Tour Begin :
Special Request :

Details of Identity:
Salutation :	Mr. Mrs.
Family Name :	*
Given Name :	*
Date of Birth :	(dd/mm/yy)
Nationality :
Passport No. :
Date & Place of Issue :
Address :	*
City :	*
State :	*
Zip Code :	*
Country :	*
Office Phone :	Fax :
Home Phone :	Fax :
Mobile Phone :
Comments / Request :

IMPORTANT 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.

In case of some server problems You can send also an standard E-Mail with Your requests to: info@bali-romantic.com

After You send this Form we will inform You - soon as possible -
if Your requested Hotel (or Tour Program) is available.

Please Note that we do not hold any reservation for You until we have a full deposit payment.
If your reservation has been confirmed, credit card details sent via facsimile is required to secure your reservation.

Bali-Romantic.com / GRIYASARI TOURS & TRAVEL
Jl. Gatot Subroto No. 49
Kesiman - Kertelangu
Denpasar - Bali - Indonesia
Phone :+ 62 - 361 - 461910, 467459
Fax : +62 - 361 - 461131
E-Mail: grsari@indosat.net.id

E-mail : info@bali-romantic.com