Romantic-Weddings.com: Booking Form

Booking Form

Booking Date	:	(please do not edit)
Wedding Type / Agreed Price	:
Venue	:
Date	:

GROOM
Full Name	:
Nationality	:
Passport Number	:
Place of Birth	:
Date of Birth	:
Religion	:
Business Title	:
Phone	:
Fax	:
Email Address	:
Permanent Address	:

BRIDE
Full Name	:
Nationality	:
Passport Number	:
Place of Birth	:
Date of Birth	:
Religion	:
Business Title	:
Phone	:
Fax	:
Email Address	:
Permanent Address	:

Notes: I/we hereby apply for the above accommodation and warrant that I/we have read, understand, and agree to the Terms & Conditions as displayed on Romantic-Weddings.com/Bali.com Ltd's current web site. I/we authorize you to charge the credit card specified hereunder according to your Terms & Conditions. Reservations can be processed only after receipt of complete credit card details. Please send them by fax to +62-361 701-577 TODAY.

Type of Card:	:	I'll fax it Today
Issuing Bank:	:
Card Number:	:
Expiry Date:	:
Name of Cardholder	:
Address of Cardholder	:

Please print this form after completion, sign it and fax it to +62-361 701-577 Signature: