IBIS STYLES BALI KUTA CIRCLE

Address : Jl. Bypass Ngurah Rai – Simpang Dewa Ruci No. 99 , Kuta – Bali 80362
Phone : 0361 – 8948999
Fax : 0361-8948555

CREDIT CARD AUTHORIZATION FORM Date :

This letter authorized Ibis Styles Bali Kuta Circle to charges the following Credit Card :

Name of Guest / Group :

Period of Stay :

I hereby, agree to be personally liable for the full statement of charges, as specified :

IDR (Indonesian Rupiah) Amount : IDR.

Please charges the above amount to my Credit Card is as follows :

Credit Card Type

(Amex, BCA, Diners, JCB,Master,Visa) : _______________________________________

Credit Card Number

: _______________________________________

Expired Date
(xx/xx) : _______________________________________

Card Holder Name : _______________________________________

Card Holder Signature : :

I agree that this agreement is irrevocable

Name : _____________________________________

Mailing address : _______________________________________

E-mail address : _______________________________________

Phone Number : _______________________________________

Fax Number : _______________________________________

According the Indonesian Law, the settlement by credit card is charges by local currency (IDR)
The hotels take no responsibility for subsequent exchange rate used by credit card company after check out.

Please kindly attach the copy of Credit Card & Identity Card of the Card Holder
and send back to the hotels
By Fax to : Reservation (Sales Department ) : +62-361-8948555
By E-mail to : Reservation (Sales Department) : H8118-re1@accor.com
IBIS STYLES BALI KUTA CIRCLE
Address : Jl. Bypass Ngurah Rai – Simpang Dewa Ruci No. 99 , Kuta – Bali 80362
Phone : 0361 – 8948999
Fax : 0361-8948555

CREDIT CARD AUTHORIZATION FORM Date :

This letter authorized Ibis Styles Bali Kuta Circle to charges the following Credit Card :

Name of Guest / Group :

Period of Stay :

I hereby, agree to be personally liable for the full statement of charges, as specified :

IDR (Indonesian Rupiah) Amount : IDR.

Please charges the above amount to my Credit Card is as follows :

Credit Card Type

(Amex, BCA, Diners, JCB,Master,Visa) : _______________________________________

Credit Card Number

: _______________________________________

Expired Date
(xx/xx) : _______________________________________

Card Holder Name : _______________________________________

Card Holder Signature : :

I agree that this agreement is irrevocable

Name : _____________________________________

Mailing address : _______________________________________

E-mail address : _______________________________________

Phone Number : _______________________________________

Fax Number : _______________________________________

According the Indonesian Law, the settlement by credit card is charges by local currency (IDR)
The hotels take no responsibility for subsequent exchange rate used by credit card company after check out.

Please kindly attach the copy of Credit Card & Identity Card of the Card Holder
and send back to the hotels
By Fax to : Reservation (Sales Department ) : +62-361-8948555
By E-mail to : Reservation (Sales Department) : H8118-re1@accor.com