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RESERVATION FORM

Guest Name
your real name (same as your id /passport)
E-mail Address :
Bali - Hotel Name :
Bali - Hotel Phone No.:
Booking Date :
dd/mm/yyyy
Booking Time :
Number of person(s) :
male, female
Select Package or Treatments I:
Select Package or Treatments II:
Select Package or Treatments III:
Select Package or Treatments IV:
Select Package or Treatments V:
Select Package or Treatments VI:
Type of Rooms :
Double/Couple Rooms
Single Rooms
Special request :
Captcha :