Please fill in the form below to send your credit
card details to us. First, click the bottom
"print this form!" below and fill
in the form completely including the copy of your
credit card and passport. Second, send it by
facsimile.
IMPORTANT : This credit card details are only
for a guarantee. IT IS NOT DEPOSIT NOR PAYMENT. Payment
is to be made directly to the hotel when you check
in either by cash or credit card
| I hereby
authorize _____________________ approved
by Baliplan.com to use my credit card as
specified here under according to your TERMS
AND CONDITIONS in order to guarantee room
accommodation at _____________________ for
____ night(s). Arriving on ________________
and departing on _______________
|
| Card
Holder's Name |
:
__________________________________ |
| Type
of Card |
:
__________________________________ |
| Card
Number |
:
__________________________________ |
| Issuing
Bank |
:
__________________________________ |
| Expiry
Date |
:
__________________________________ |
|
Card Holder's signature :
|
|
For
further information please contact :
|
|
Baliplan.com
Bali Hotel and Villa Reservations
Jalan Tukad Pancoran 16, Denpasar - Bali,
Indonesia
Phone/Fax: +62 (361) 245505
|
|
Print this form!
|
