BALIBUDGET ACCOMMODATION
CREDIT CARD DETAILS & AUTHORIZATION FORM

I,                                                                           herewith inform my credit card details to guarantee my reservation at

Name of Hotel or Resort:

                                                                                    
Arrival Date:                                                                                     
Check-In Date:                                                                                     
Check-Out Date:                                                                                     

If cancellation is occur as stated in Terms & Conditions, I authorize Kunang Kunang Paradise Bali to charge my credit card as a Cancellation Fee, charged at first one night accommodation

In Amount US$:

                                                                                    
Credit Card Type:                                                                                     
Credit Card Number:                                                                                     
Cardholder's Name:                                                                                     
Expiry Date:                                                                                     
Name of Issuing Bank:                                                                                     
Cardholder's Signature:                                                                                     
Date:                                                                                     

Front and Back copy of the credit card is required

Front Copy Back Copy

ONCE FORM IS COMPLETED, KINDLY FAX TO +62 361 974 923

Please attach copy of your Passport as well.
Thank you for booking with Balibudget Accommodation
Balibudget Accommodation - CV. Bali Trip

Jalan Raya Sayan, Ubud, Bali - INDONESIA
Tel. / Fax. +62 361 974923 Mobile Phone +62 (0) 812 395 2032
E-mail: bbainfo@bali-thepages.com

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