Travel Booking Form for Bali 2025 Queens Travel Group

Travel Booking Form for Bali 2025 Queens Travel Group
Full Name (As Per Passport) *

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth *
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name First Name* Last Name*
Emergency Contact Phone Number Area Code* Phone Number*
Select Villa Option*

Option 1 Room Type Selection Single Room (Pool View): $2991.50 total Deposit: $500 due on **October 27, 2024** Balance: $2491.50 Monthly Payment: $311.43 per month Last payment due on **June 27, 2025**Option 2 Single Room (Garden View): $2791.40 total Deposit: $500 due on **October 27, 2024** Balance: $2291.40 total Monthly Payment: $286.42 per month Last payment due on **June 27, 2025**Option 3 Double Room (Pool View): $4096.00 total ($2048.00 per person) Deposit: $1000 ($500 per person) due on **October 27, 2024** Balance: $3096.00 total Monthly Payment: $387.00 per month ($193.50 per person), Last payment due on **June 27, 2025**Option 4 Double Room (Garden View): $3701.00 total ($1850.50 per person) Deposit: $1000 ($500 per person) due on **October 27, 2024** Balance: $2701.00 Monthly Payment: $337.62 per month ($168.81 per person) Last payment due on **June 27, 2025**
**Roommate Information** (if applicable):
   - Name of Roommate
   - Roommate’s Contact Information
   First Name   Last Name   Area Code   Phone Number
Will you need assistance booking flights?

YesNo
If yes, please provide the following. *Departure City *Preferred Departure Date *Return Date
Include Any Medical Accommodations Needed
*Itenerary Included In Total Amount*

Arrival *Meet and Greet* (July 10,2025)

Tegalalang Rice Terrace & Monkey Forest (July 11, 2025)

ATV Adventure & Group Dinner (July 12, 2025)

Gates of Heaven Tour (July 13, 2025)

Cretya Day Party & Waterfall Tour (July 14, 2025)

Free Day (July 15,2025)

Pool Party *Color Themed* (July 16, 2025)

Spa Day (July 17, 2025)

Depart (July 18,2025)
Payment Plan Selection

Pay in fullMonthly installment planDeposit only
*Terms and Conditions*

**Cancellation Policy**

   - I have read and understand the cancellation policy for this trip.

   - Acknowledge that the deposit is non-refundable after October 27, 2024.

   - Agree to make payments on time and understand that missing payments may result in cancellation of booking.
Room Selections:*
prevnext( X )
Single Pool View
$2,991.50 Quantity



Single Garden View
$2,791.40 Quantity



Double Pool View
$4,096.00 Quantity



Double Garden View
$3,701.00 Quantity



Deposit
$500.00 Quantity



Total

$0.00
Signature

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Website: https://queenstravelgroup.com

Email: info@queenstravelgroup.com

Phone: 714-684-6427
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