Autorization Of Credit Card for payment quarantee
CREDIT
CARD AUTHORIZATION FORM FOR LETER QUARANTEE
Please
print thiscredit card authorization
form and send to :
+62-361-466865
IMPORTANT
: Your credit card will be used as a guarantee ONLY
and will be charge 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
CREDIT CARD STATEMENT
Hereby, I with the details below, authorized by Bali Turista, Sanur
Raya PT c/o Betngandang I Sanur - Bali, to charge my credit card
as specified for the payment of my reservation as follow:
Accommodation Information :
Client's name :
Hotel Name:
Number of person:
Adult
Child
Room Type:
Check In
Check Out
Rate :
Inclusive :
Bank Fee:
4 % x USD =
USD
Total Charge
USD + USD
= USD
Total Charge in IDR
USD
x Rp.
= Rp
*Type
of Credit Card :
VISAMASTER CARDAMEX
JCB
*Credit
Card Number :
*Expiry
Date (MM/YY) :
/
(As shown on card)
Bank Name Of the Card :
*Passport
Number :
Country / Nationality
:
*Birth
Day :
*
If your card is VISA/MasterCard/JCB, your
credit card number exactly consits of 16 + 3 = 19 digit,
please find 3 number at back side of
your card : ...........
*
If your card is AMEX : jot number that totals 19 digit
all of which are on the front of credit card, consisting
of 15 digit number and the 4 digit
number located at the top side of your card, right after
the 15th digit :.......................................
*
Important, please advise your billing address
:...............................................
..................................................................................................................
I Notice And Confirm:
*
The transaction will be in Indonesia
Rupiah as per above exchange rate
*
NO REFUND for early check out
*
Cancellation made 14 days prior to arrival date,
will be subject to one night cancellation fee
Cancellation made 7 days prior to arrival date or
No show will be subject to full room nights cancellation
fee.
