Jl. KH.

Cholid Samid
Gg. Aduma (Di Jalur Sungai Belakang Bangka Pos dan Taman Elite)
Tlp. 0717 - 431663

REGISTRATION FORM

NEW RESERVATION

AMENDEMENT TITLE SURENAME FIRST NAME

CANCELLATION MR/MRS/MISS
BOOKING

DETAIL

ARRIVAL DATE DEPARTURE DATE NUMBER OF ROOM ROOM TYPE DAILY RATE

ADDRESS : NUMBER PHONE :

Arrival Time :

PERSONAL ACCOUNT
CASH DEPOSIT

RP. RP.

BREAKFAST TIME : (COFFEE / TEA)

INITIAL : DATE :

CLERK : SIGNATURE :

Check out Time :

Number Register

227