Kampung Aman Booking Form

 Name:

Check in date: 

         /         /          

 Flight Number:

                               Arrives          :       hrs

Check out date: 

         /         /          

    Total number: 

Adults:          Children:         

 Total number of nights: 

    Rental Fee
(@A$150 per night): 

    Minimum Deposit 30%:

A$                       Balance A$                   

If you have any special requests such as a meal upon arrival, please include these on a separate fax or e-mail.

I/we hereby acknowledge that we have read the terms and conditions related to the hire of the Villa known as Kampung Aman and agree to abide by these terms and conditions.

Signed: 

Print Name:

Email address:

Telephone:

Home                                                 

Passport number: 

                                       Expiry date:                         

Nationality: 

Billing Address
(for statements):

___________________________________________________________________

Fax to: (03) 5472 4396 (Australia) or 974 647 (Bali)