APNIC 40 Reservation Booking Form
2nd – 11th September 2015
Please complete this form and send to [email protected] to secure your booking.
Guest Information
Guest No. 1 Name
First Name :
Last Name :
Guest No. 2 Name
First Name :
Last Name :
Organization
Contact Details
Phone :
Email :
Check In Date
Check out Date
Please indicate room
___ Executive King Room including breakfast for 1 pax – Rp. 1.118.000 nett/ night
type and rate you
___ Mars & Venus Suite including breakfast for 2 pax – Rp. 1.248.000 nett/ night
wish to book
___ Manhattan Suite including breakfast for 2 pax – Rp. 1.368.000 nett/ night
Above rate includes :
 21% tax & service charges
 Breakfast at Central Park Restaurant
 Free internet access
 Free access to Swimming Pool and Gymnasium
Credit Card Guarantee
Name on the Card
Card Type
Card Number
Expiry Date
CVC: Back of card
Mastercard / Visa / Amex
Only.
Terms and conditions:

The special rates are available on 2 – 11 September 2015 subject to availability

For payment by Credit Card, please provides :
1. Scan of front and back side of Credit Card
2. Scan of passport of Credit Card holder
Cancellation Policy:

Cancel 48 hour cancellation policy, before 2pm, 2 days before your arrival date

No-show reservation will be charged full length of stay

Non-Guaranteed Reservations, the rooms/suites will be released by 6:00 pm on the arrival date
I agreed to the terms & conditions provided by above mentioned company and submit this form as the
confirmation of payment.
Thank you.
(Signature as per credit card)
Name:
If you have any doubts or queries, please contact Ms. Stefhani on +62 21 300 40 888 or +62 812 8349 7621