TO: LOVINA BEACH HOTEL

  Desa Kaliasem - Pantai Lovina

Singaraja- Bali  81151 

 

 

Please print this page.

Fill out the form and

send it  back to us by fax

Fax no: 62-362-41473

 

INDEX

ROOM PRICE

THE HOTEL

PLACES

LOVINA MAP

ROOM TYPE

PRICE: US$

ROOM QUANTITY:

 NUMBER OF NIGHTS

SUB TOTAL US$

    SUITE ROOM

DE LUXE

STANDARD ROOM

ECONOMY ROOM

 ____________

____________

____________

____________

___________

___________

___________

___________

________

________

_________

_______

___________

___________

__________

___________

EXTRA PERSON

___________

___________

_________

___________

TRANSPORT / AIRPORT TO LOVINA

 ___________

 

TOTAL AMOUNT >>

__________

 

In case you do not check in as planned, we charge you 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

  Credit Card No.  _____________________________ 
  Expiring Date: ____________/________________
  Name On Card _____________________________
  Today's Date _____________________________
  Signature __________________________