Payment

IMPORTANT : Your credit card will be used as a guarantee ONLY and will be charge if there is any cancellation within certain period of cancellation policy. All payment will be collected upon arrival in Bali except for reservation beyond Bali

Confirmation Letter for Credit Card Guaranteed Reservation

Accommodation Information :
Booking Reference:
Hotel Name:
Room Type:
2nd Choice Hotel Name:
No. of Room (s):	No. of Adult (s):
No. of Children (s):	Ages of children:
Extra Bed Required:
Check In
Check Out
Special Requests:
Total Amount :
Airport Transfer:

I wish to confirm and guarantee my reservation by :

Credit Card Information :
Please be assured that we will not debit your credit card until you have agreed on the accommodation and until your reservation is confirmed.

*Type of Credit Card :

VISA

MASTER CARD MoneyGram

*Credit Card Number :

*Expiry Date (MM/YY) :

/ (As shown on card)

*3 Digit Code After Card # on Back of Card :

(as shown on the signature panel on your card)

*Name as it appears on card :

First Name

Middle Name

Last Name

(As shown on card)

*Card Holder Address :

*City :

*State or Province :

*Postal Code :

*Country :

Phone :

*Email Address :

*Signature :

Signature

(............................................................)

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