Folio Number : 08912 Pax : 2

Name : Taufik Afdal, Mr Payment : CS

Contact : 085765648325 Room Number : #4123
Address : Jl. Sultan Mahmud Rt. 01 Room Rate : Rp. 550,000
Rw. 04 No. 20 Arrival Date : 28-Nov-2013
Tanjungpinang Departure Date : 29-Nov-2013
City/State : INA

User ID :KARTIKA
Date Transaction Description Charges Credits

28-Nov Room Charge Room Charge 28 – 29 Nov Room #4123 – 2 N 1,100,000.00

Service Charge Room Service Charge Room Room #4123
Tax Room Tax Room #4123
29-Nov Deposit Cash DPST #4123 – 2 N 1,300,000.00 1,100,000.00

Page 1 of 1 Balance (200,000,00)

I AGREE THAT MY LIABILITY FOR THIS BILL IS NOT WAIVED AND

AGREED TO BE HELD PERSONALLY LIABLE IN THE EVENT THAT THE
INDICATED PERSON, COMPANY OR ASSOCIATION FAILS TO PAY ANY SIGNATURE :
PART OR THE FULL AMOUNT OF THESE CHARGES

Jalan Industri Raya No. 8 Gunung Sahari Jakarta 10720, Tel: (62-21) 6231 7788 (Hunting), Fax: (62-21) 6231 7799
Website: www.orchadshotel.com