Confirmation Letter for Credit Card Guaranteed
Reservation Cempaka Belimbing Villa
Accommodation Information :

Booking Reference:

  

Hotel Name:

 

Room Type:

 

2nd Choice Hotel Name:

  

No. of Room (s):

No. of Adult (s):

No. of Children (s):

Ages of children:

Extra Bed Required:

  

Check In

 

Check Out

 

Special Requests:

  

Additional Requirements:

  

Airport Transfer:

  

I wish to confirm and guarantee my reservation by :

Credit Card Information :
Please be assured that we will not debit your credit card until you have agreed on the accommodation and until your reservation is confirmed.

*Type of Credit Card :

VISA MASTER CARD JCB SCB

*Credit Card Number :

  

*Expiry Date (MM/YY) :

 / (As shown on card)

*3 Digit Code After Card # on Back of Card :

 (as shown on the signature panel on your card)

*Name as it appears on card :
First Name Middle Name Last Name
     
(As shown on card)

*Card Holder Address :

  

*City :

  

*State or Province :

  

*Postal Code :

  

*Country :

Phone :

  

*Email Address :

  

*Signature :

  

Signature

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