Please fill out the form below completely as this will enable us to make suitable suggestions tailored to your specific requirements. 

Number of people:

Adults
  Children

Number of bedrooms required:

Please rate the importance of the following facilities and services on a scale of Very Important, Important and Not Important:

Facilities/Services

Very Important Important Not Important
Air-conditioned room

Swimming pool
Close to beaches
Close to rice paddies
Close to Shopping/Entertainment centers
IDD Telephone/Fax
Satellite TV & stereo system
Private bathroom
Private kitchen
Car Rental
Your main interests and planned activities during your visit to Bali.

Relaxing
Exploring Bali's culture and religion.
Business
Adventure
Sports
Other

Please specify:

Other special requests:

Amount you would expect to pay per villa per day 
US$ 150 - up to US$ 400
US$ 500 - up to US$ 900
US$ 1,000 - up to US$ 1,500+
Personal Details
Salutation:

Full name:
Business title:
Nationality:
Full postal address:
City/Zip Code:
State:
Country:
Email:
Telephone:
Facsimile:
Flight Details
Scheduled arrival date:
Scheduled departure date:
Flight number:
Other information
Have visited Bali before: Yes
No
If Yes, where did you stay:
Have rented a vacation villa before: Yes
No
If Yes, when and where:
How did you discover this website:

  

Thank you for your time in completing this form we will attend to your inquiry promptly.

 

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