Bali Tour Bookings

CREDIT CARD DETAILS BY FAX FORM

To : Bali Tour Bookings
Facsimile No. : +62-361-974923

I,_____________________________________________________________ have sent you a tour / villa reservation request via the Internet/e-mail, without my credit card details on the form.

These are my credit card details, which I hereby authorize to be used for the deposit and balance of account / any cancellation charges in respect of the villa(s) I have asked you to reserve for me.

Type of Card	:
Card Number	:
Expiry Date	:
Cardholder's Name	:
Cardholder's Signature	:
Notes	:

I am sending you a copy of my credit card (front & back) and a copy of my passport, if you have not received my reservation request yet, please contact me on:

Telephone No.	:
Facsimile No.	:
Email Address	:

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