Reservation Request Form

Date Arrive (mm/dd/yr):

(ie. Jan 12, 99 or 12 Jan 99)

  Flight No. :

Date Depart (mm/dd/yr):
Flight No. :
Number people : Adults:    Children:  
Number rooms :
Preferred bed type :
Type of room :


Personal Information. Please fill in all fields.

First Name :
Last Name :
Address :
City :
State/Province :
Country :
Postal Code :
Telephone :
Fax Number :
E-mail: - Mandatory
How did you learn about paradise-bali.com ? - Optional

(To Book more than one room type or request extra bed, please use comments below).

Room reservation and desired bed type subject to availability
Reservation is not confirmed without Booking Confirmation Code
All Rates Inclusive of  21% Gov't Tax & Service Charge. No Hidden Charges

Comments, requests or questions:


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Thank you for letting paradise-bali.com serve you. Enjoy your visit to Bali.