Kesumasari Hotel Reservation Form
Personal Information
Title
-
Mr.
Mrs.
Ms.
*Name
Nationality
Phone (w/ area code)
Mobile (w/ area code)
*E-mail
Arrival Information
Check in Date
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January
February
March
April
May
June
July
August
September
October
November
December
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
2008
2009
2010
2011
Arrival Flight No.
Check out Date
-
January
February
March
April
May
June
July
August
September
October
November
December
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
2008
2009
2010
2011
Departure Flight No.
Desired Room Accomodation
*No. People
Adults:
Children :
Child's Age:
*Total Room
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Single
Double/Twin
Triple
Other (please specify in description below)
Room Type
Other Service
Extra Bed Requirement
Airport Transfer
-
Yes
No
Please describe your inquiries in details
All field are required and the field with * sign is the most required.
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