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Copyright ©
www.balihilton.com
Official website of
Bali Hilton International

MAKE YOUR STAY GRAND IN BALI
RESERVATION FORM

Personal Information
Salution:
*First Name:
*Last Name:
*KTP/KITAS:
*E-mail:
Phone:
Fax:
Address:
City:
State:
Zip Code:
Country:
Sex:
Date of Birth:
Nationality:
Company:
*) Required
Flight Information
Arrival at Bali  
Flight Number:
Arrival Date:
Arrival Time:
   
Departure From Bali  
Flight Number:
Departure Date:
Departure Time:
   
Reservation Information
Check-In Date:
Check-Out Date:
Room Choice:
Number of Room(s):
Extra Bed Required: Yes No
Number of Extra Bed(s):
Number of Persons(s):
Note:
   
Credit Card Information
Card Type:
Name on the Card:
Card Number: - - -
Expiration Date:
IMPORTANT: PLEASE NOTE THAT BY CLICKING THE "Send Request" BUTTON BELOW TO
SUBMIT YOUR RESERVATION REQUEST TO US, YOU AGREE WITH & ACCEPT THE TERMS AND CONDITIONS.