BALI BOOKING FORM (IN SYSTEME FORM)

Reservation Reference Number*
The Reservation Number Generated /In Your Confirmation Email.
Primary Traveller Information
Your Name*

First NameLast Name
Phone Number*
Mobile preferred
Email*
bestcustomer@gmail.com
Your Address (resort may mail confirmation here)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Travel Information
Number of Adult guests*
Adults
Number of Children/Extra guests*
Children
Please select a preferred resort based and a corresponding preferred check-in day/date based on that selection.

Bali Palms and the Seascape Resort are twin properties within an exclusive gated zone.
Prefered Resort*
Requests are subject to availability
Preferred Check in date*
Second Date Option*
Third Date Option
You will be accommodated in a Hotel Room or Studio Apartment configured to sleep two adults and two children 10 years or younger.

Upgrades as below are available, subject to availability. Final payment is made directly to the hotel on confirmation of your dates.
Upgrade Room?

I Bedroom Apartment Sleeps 3 Adults + 1 Kid under 16 - $150AUD (Approx- charge in USD at resort)2 Bedroom Apartment Sleeps 3 Adults + 1 Kid under 16 - $250AUD (Approx- charge in USD at resort)2 Bedroom Apartment Sleeps 5 adults + 1 Kid under 16 - $300 AUD (Approx- charge in USD at resort)
Selection subject to availability. Additional accommodations for family members only.
I'd like to add an extra week to my stay!

YesNo
Great! You can add an extra week from just $300 - $400 AUD subject to availability and your room selection. This will be included in your booking request.

Payment is only required at time of confirmation payable directly to the resort.
Special Requests
eg- Access requirements

Demographic Information
Please complete these details to meet the details of participation of this promotion
Relationship Status*

MarriedDefactoSingle
Years Co-habitating*
Years you and your partner have shared the same home
Please note- to travel as a single guest as part of this promotional offer you cannot be travelling unaccompanied by your partner or spouse.
Your occupation*
Work Status*

Full timePart time
Household Income*
Please Select Pre-Tax Household Income Range
Your D.O.B*

DayMonthYear

Second Adult
Name*

First NameLast Name
Occupation*
Work Status*

Full timePart time
D.O.B*

DayMonthYear
Additional Guest details
If applicable (more than 2 adults/2children selected) Please add the names and ages of other guests OTHER than the primary traveller/s. Note- Other guests must be family members.