Please print this credit card authorization form and send by Fax to : (62) 361
421583 |
CREDIT CARD AUTHORIZATION FORM | VISA & MASTER CARD ONLY | | |
To secure my reservation, I hereby to authorize PT
AIDA INDONESIA DEWATA TOURS
(alliance-indonesia.com/balidives.com/indobalitravel.com) to charge my credit card as specified hereunder & Copy Credit Card + Copy Passport, attached. Being Charge for Accommodation / Tours, etc : | | Hotel Name | : ___________________________________________ | | Tours /
tickets /etc. | : ___________________________________________ | | Check-In / Out | : ___________________________________________ | | Total amount | : ___________________________________________ | |
| Type of Card | : ___________________________________________ | | Card Number | : ___________________________________________ | | Issuing Bank | : ___________________________________________ | | Expired Date | : ___________________________________________ | | Card Holder's Name | : ___________________________________________ | | | | Passport Number | : ___________________________________________ | | Date of Birth | : ___________________________________________ | Billing Address
| : ___________________________________________
___________________________________________
___________________________________________ |
I understand that credit card payment are subject to 3,5 % added bank service charge and calculated on the bank exchange rates the day processing. Also the Credit Card will charge 14 days (Low
Season) and 30 days (High season) prior to arrival/date of tour request. Differences in personal statement balances can occur and are due to the fluctuation with the Indonesian Rupiah (IDR) and bank processing time. We are not held responsible to these differences.
By sending this Credit Card Authorization Form I agree with Alliance-Indonesia.com Terms & Conditions . Card Holder's signature : | Front Copy Credit Card . . . . | Back Copy Credit Card . . . . | Copy Valid Passport Page . . . . . . | Alliance Indonesia ™
Phone: (62) - 361
412981, Fax: (62) - 361 421583
E-mail : info@ alliance-indonesia.com Website : http://www.alliance-indonesia.com |
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Upon receiving our confirmation, your credit card details is required. It will be used as a guarantee and will be charged if there is any cancellation within certain period of cancellation policy.
All payment will be collected upon arrival in Bali except for reservation beyond Bali.
We do accept cash / travellers cheque / Visa / Master Card.
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