CREDIT CARD DETAILS BY FAX FORM
To : Family Bali Villas. Com | Bali Trip International
Facsimile No. : +62-361-974923
I,_____________________________________________________________ have sent
you a villa reservation request via the Internet/e-mail, without my credit
card details on the form.
These are my credit card details, which I hereby
authorize to be used for the deposit and balance of account / any cancellation
charges in respect of the villa(s) I have asked you to reserve for me.
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| Card Number |
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| Expiry Date |
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| Cardholder's Name |
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| Cardholder's Signature |
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| Notes |
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I am sending you a copy of my credit card (front & back) and a copy of my passport, if you have not received my reservation request yet, please contact me on:
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| Facsimile No. |
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| Email Address |
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