CLICK HERE TO PRINT THIS BOOKING FORM
 
TOUR BOOKING FORM & CREDIT CARD PAYMENT AUTHORITY
TO SECURE YOUR BOOKING PLEASE COMPLETE & FAX TO +62 361 84 75 943
 

Name of Tour or Activity:                                                                                          

Tour required on date:                                               2011/2012

Total number of guests:  Adults                            Children:                                  

Amount payable per person US$                                  

Total amount payable US$                           

*I/we hereby apply for the aforementioned tour or activity on the dates specified above and *I/we authorize payment be charged to the credit card specified hereunder.

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 tour or activity in Bali.

Card Type: Visa* / MasterCard* (*Delete as applicable)

Card Number:                                                                                                                                  

MasterCard ICA Number or Visa 4 digits:                                        (MC - back of card, usually bottom right corner - Visa 4 digits on front below CC No.)

Expiry date:         /        /             

Last 3 digits in signature section on back of card (if any):                 

Name of issuing bank:                                                                       

Cardholders Name:                                                                         Date of Birth:         /        /        

Cardholders Signature:                                                                                                                  

Passport number:                          Expiry date:         /        /         Nationality:                                 

Billing Address (where the CC statements go to)                                                                            

                                                                                                                                                       

Approval Code (for bank use only):                                                                                                

Thank you for booking with Bali Vacation Rental.
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.