|CLICK HERE TO PRINT BOOKING FORM|
|TO SECURE YOUR BOOKING PLEASE COMPLETE THIS BOOKING FORM
THEN FAX TO +62 361 84 75 943
Type of Jump: TANDEM SKYDIVE FROM
I hereby authorize the payment of US$ be converted to Rp. (Indonesian Rupiah), and charged to my credit card as payment for the aforementioned Tandem Skydive.
Card Type: Visa* / MasterCard* (*Delete as applicable)
Last 3 digits in signature section on back of card (if any):
Name of issuing bank:
Cardholders Name: Date of Birth: / /
Passport number: Expiry date: Nationality:
Billing Address (where credit card statement goes to)
Approval Code (for bank use only):
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.