Please fill this form for our information. (Silakan mengisi blanko di bawah ini sebagai informasi buat kami.) Name (nama) : Sex (jenis kelamin) : Male/Laki-laki Female/Perempuan Address (alamat) : State & Country (negara) : ZIP (kode pos) Number of person (jumlah yg datang) : 1 2 3 4 5 6 more than 6 If more than 1, please type name and sex of the others in text area bellow : (bila lebih dari satu, tolong ketik nama/jenis kelamin yang lainnya dlm kotak di bawah ini) - name/nama (sex/jenis kelamin) Planned arrival (rencana kedatangan) : date/tgl 123 4567 891011 12131415 16171819 20212223 24252627 28293031 month/bln JanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctoberNovember December year/thn 1999 2000200120022003 2004200520062007 200820092010 Arrival place (tempat kedatangan) : Railway station "Baranangsiang" bus station Approximate arrival time (perkiraan waktu kedatangan) : hour/jam 010203 04050607 08091011 12131415 16171819 20212223 24 minutes/menit 01-0506-10 11-1516-2021-25 26-3031-3536-40 41-4546-5051-55 56-59 am/pm AMPMWIB You want us to pick up (ingin dijemput ?) : Yes/ya No/tidak You want to be booked room/s (ingin dipesankan kamar ?) : Yes/ya No/tidak If Yes (bila ya) : 0123 4567 8910more than 10 single room/s 0123 4567 8910more than 10 double room/s class/kelas lower/murahmiddle/sedang upper/mahal stay duration/lama tinggal : from date/month (tgl/bln) till (s/d) Any message/suggestion/comment ? (ada pesan ?) : You may type here (silakan ketik di sini) Back to Our Services Page
