Please print this page.
Fill out the form and send to
LOVINA BEACH HOTEL
Fax no: 62-362-41473
ROOM TYPE
PRICE: US$
ROOM QUANTITY:
NUMBER OF NIGHTS
SUB TOTAL US$
SUITE ROOM
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DE LUXE
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STANDARD ROOM
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ECONOMY ROOM
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EXTRA PERSON
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TRANSPORT / AIRPORT TO LOVINA >>
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TOTAL AMOUNT >>
 
In case you do not check in as planned, we charge you only for one night accommodation and airport pick up
service as per request, which are not refundable.
The total amount of the room and other services are payable at the end of your stay.
Please note: we do not charge credit card  in advance.
First Name  :
 
Last Name  :
 
Full Address:
 
Telephone   :
 
E-mail         :
 
CREDIT CARD INFORMATION & AUTHORIZATION
[  ]   VISA       [  ]  MASTERCARD     [  ]  JCB
Name On Card:
 
Credit Card No.:
 
Expiring Date:
/
Name On Card:
 
Today's Date:
 
Signature: