BOOKING CONFIRMATION FORM

BOOKING CONFIRMATION FORM
This form should only be completed after Amazing Luxury Villas has made a tentative booking for your chosen villa and sent you an email confirming your booking. If you would like to choose an appropriate villa, please click here.
THE CLIENT
SURNAME (BLOCK CAPITALS) Name as it appears on passport	Initial	Title		Address	Emergency Contact Details











HOLIDAY DETAILS
Villa Name :
Arrival Date :
Departure Date :
Special Requests : (Special requests can not be guaranteed unless confirmed in writing by Amazing Luxury Villas)

CONTACT DETAILS
Name :
Company Tel. :
Home Tel. :
Email :
Fax :
Emergency Service Tel. No. :

PAYMENT DETAILS
You can pay for your Amazing Luxury Villa by credit card or bank transfer. Our banking details are:
Account Name:			PT. Rumah Asia
Bank Name:			Permata Bank Sanur Branch
Address:			Jl. Danau Tamblingan, Sanur, Bali, Indonesia
Swift Code:			BBBAIDJA
Account Number:			5802142198

CREDIT CARD DETAILS
Credit Card Type (Visa or Mastercard):
Amount for credit card payment :			US$
Name as it appears on your card :
Card Expiry Date :
Credit Card Number :

SIGNATURE

Thank you for choosing Amazing Luxury Villas

Click on save & print to print a copy of your confirmation form.
Please sign the completed form and fax it to (62 361) 737 557

.: Please wait a moment while we process your information. Many thanks for booking through Amazing Luxury Villas. :.