Hotel Map
 
Simpang Inn The Greenest Inn
 
Credit Card Form

I wish to confirm and guarantee my reservation by :

Credit Card Information :
Please be assured that we will not debit your credit card until you have agreed on the accommodation and until your reservation is confirmed

Type of Credit Card
 
Credit Card Number
 
Expiry Date (MM/YY)
 
3 Digits # on Back Cover of Card
(for VISA/MASTER)
 
4 Digits # on Front Cover of Card
(for AMEX)
 
Credit Card Holder Name
 
Card Holder Address
 
City
 
State or Province
 
Postal Code
 
Country
 
Phone
 
Email Address
 
Signature
 
     

 Signature

 (……………………………………..)


Kindly return the copy after having duly sign for our reference via fax.
+62 – 361 - 430739
 
 
 
 
Simpang Inn Jl. Legian No. 133, Kuta, Bali, Indonesia
 Online Support : Simpang Inn Kuta   Phone Reservation : +62.361.8070181

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