ACCOMODATION BOOKING REQUEST FORM

REQUESTER

First Name Danang Last Name Supriyono

Company Name PT Samudera Sarana Logistik

City Jakarta Utara Postal Code 14130

Country Indonesia Billed to

I am not staying in any of the rooms on this booking. I am making this booking for someone else.

BOOKING INFORMATION

Where would like you to go?

 Destination Country Check - In
dd/mm/yy (e.g 01Aug17)

26 juli 2018

Destination City

How Many Room 1

Travelers Information
First Name Deny Hotel Category X Star ** Star ***

Last Name Faisal Hotel Name Hotel Amaris Thamrin

ID Number
(KTP/Passport)
Room Type Staandart
E-mail dany.faisal@samudera.if

Bed Type Double Bed

Breakfast Included YES

Please be aware that all requests are subject to availability

Comment field:
Comment field:

COMPLETE GUEST NAME

No First Name Last Name ID Number (KTP/Passport)

1 Deny Faisal

5
FORM

ono Telephone 021-4401592 ext 6572

Mobile 081219645901

Fax

E-mail danang.supriyono@samudera.id
 Check - Out Night('s)
dd/mm/yy (e.g 01Aug17)

28 juli 2018 2

Star ****

(e.g Standard, Superior, Deluxe, Suite)

(e.g twin bed & double bed)

/Passport) Expiry Date of Birth
dd/mm/yy (e.g 01Aug17) dd/mm/yy (e.g 17Aug45)