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Hotel Patra Jasa RESERVATION FORM
Please complete this form to request your room.
Arrival Information
Arrival Date
 *
Flight No.
Departure Date
*
Flight No.
 
Desired Room Accommodation
No. People
 Adults:  Children: Age:
No. Rooms
Transfer In
Yes No
Transfer Out
Yes No
Preferred Bed Type
Please select
 
Your name and how to contact you
*First Name- required
*
*Last Name- required
*
Street Address 1
Street Address 2
City
State / Province
Country
Telephone (with area code)
Fax (with area code)
*E-mail- required
*
Your visit purpose?
How did you learn about Us?
 
Notes:
All Rates Inclusive of 21 % Gov't Tax & Service Charge. No Hidden Charges
All reservations subject to room availability
 
Hotel Cancellation Policy: Cancellation notice given less than 72 hours prior to scheduled arrival or no show the hotel may charge for one night stay. During High/Peak Season cancellation policy will be advised.
Comments, requests, questions

*** IMPORTANT ***
Before clicking the submit button .
PLEASE NOTE THAT BY CLICKING THE "SUBMIT BUTTON" BELOW TO SEND THIS FORM TO US, WE STATE THAT YOU AGREE WITH THE TERMS AND CONDITIONS.

YOUR RESERVATION WILL BE PROCEED ONLY IF THE FORM HAS BEEN FILLED COMPLETELY.
Your reservation will be confirmed as soon as possible.

BEFORE YOU PRESS SUBMIT PLEASE CHECK YOUR EMAIL ADDRESS. WE CAN NOT
PROCESS YOUR RESERVATION WITH OUT IT OR WITH IT INCORRECT

     

 
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