C o n t a c t

Direct to:
Jalan Raya Petitenget 88x
Banjar Umasari - Petitenget
Kerobokan Kelod - Kuta - Bali - Indonesia
P. +62(361) 847 5470 / 847 5471
F. +62(361) 847 5469
E. casaindigo@dps.centrin.net.id
W. www.casaindigobali.com
or fill this form:
Name
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Email
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RESERVATION FORM
Email Address :
* I would like to :
* Room Type :
Require Airport transfer?:
Yes No
* Number room(s) :
* Arrival date :
(mm/dd/yyyy)
Arrival Flight Details :
* Departure date :
(mm/dd/yyyy)
Departure Flight Details :
* Number of Pax(s) :

Details of Identity

* Name :
Date of Birth :
(mm/ddd/yyyy)
Nationality :
Passport No. :
* Address :
* City :
* State :
* Zip Code :
* Country :
Office Phone :
   Fax :
Home Phone :
   Fax :
Mobile Phone :
Special Request :
Note; (*) Required

Important : Reservation will be proceed only if either one of these forms has been filled in completely.
Payment Confirmation (By internet/email)
For the need of Payment Confirmation, you have to send your credit card details to us. You may transfer your credit card details either by internet or facsimile.

   
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