Reservation by On-Line

Label:







Name (as written on your ID/KTP) :



Address (as written on your ID/KTP) :



Your ID/KTP/Passport No. :



Cellular Phone No. :



Office/Home Phone No. :



Email Address:



Type of reservation :
For a/couples of Rooms

For The Whole House

I will check-in on (dd/mm/yy):



I will check-out on (dd/mm/yy):



Room Type :



Payment by :
Transfer ATM BCA

Transfer ATM Bersama

Cash to Puri 188




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