Dewata Beach Hotel: Reservation Form

DEWATA BEACH HOTEL
Banjar Berawa, Desa Canggu, P.O. Box 3271
Denpasar - Bali - Indonesia
Phone: (62 - 361) 730263 * Fax: (62 - 361) 730290
E-mail: dewatabh@indo.net.id

Reservation & Brochure Request Form

Tick one of the boxes below: I would like to:
book a room ask for a brochure

Full Name:    
Arrival Date:           Flight No: 
Departure Date:         Flight No: 
Room Requirement:
No. of Rooms:   
Room Rate:     
Credit Card:   
Card Number:       Exp. Date: 
Email Address: 
Phone:         
Fax:           
Mailing Address:
 
Note:

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