CREDIT CARD AUTHORIZATION FORM
Reservation Code: ________________

Your Credit Cards will not be charged until we confirm the reservation.


 

    I hereby authorize ABL Tours and Travel Ltd. to charge my credit card as

    specified hereunder according to your TERMS AND CONDITIONS in order to

    pay room accommodation at ___________________  for ____ night(s).

    Arriving on ________________  and departing on _______________
Card Holder's Name : __________________________________
Type of Card : __________________________________
Card Number : __________________________________
CVV Or DC : _____ ( 4 or 3 last digit numbers which not embossed).
Issuing Bank : __________________________________
Expired Date : __________________________________
Passport Number : __________________________________
Date of Birth : __________________________________
Nationality : __________________________________
Billing Address

 :
  __________________________________

  __________________________________

  __________________________________
Total Amount : __________________________________


    I consent to pay the transaction in INDONESIA RUPIAH according to the

    exchange rate at the time of billing, which will be charged 14 days prior

    to the date of my arrival on a low season and 30 days on a peak season.

    Card Holder's signature :

     
ABL TOURS AND TRAVEL LTD.
Jalan Gunung Soputan, Perumahan Puri Taman Umadui Blok B-21,
Denpasar, Bali, Indonesia
Email : ablreservation@baliwww.com Website : http://baliwww.com/abl
Phone : (62-361) 731520 (Hunting)  Fax : (62-361) 734379 or 735145