ETN Hotel Reservation Form for
CEMPAKA BALI GUEST Hous, DENPASAR,Bali

This Reservation Form is sent DIRECTLY to CEMPAKA BALI GUEST Hous by E-Mail.
(NOT to the ETN Head Office, NOT to a travel agent or any other office)
CEMPAKA BALI GUEST Hous will answer your request as soon as possible.
If your reservation is confirmed, CEMPAKA BALI GUEST Hous will send you a Confirmation Number, the applicable GROSS or RACK Rate and the Discount Given.

Your details:

Family Name:
Initials:
Company Name: Optional !
Position: Optional !
Profession: Optional !
Street / P.O.Box:
City + State:
Country:
Postal / Zip Code:
Telephone Number: incl.Country + Area Code
Fax Number: incl.Country + Area Code
E-Mail: Absolutely necessary !
ETN Card Number:
ETN Card Expiry Date:

YES, I want to reserve the following Accommodation:


INDONESIA 80001    DENPASAR,Bali      P.O.BOX 337, Jl.IMAMBONJOL 599,KUTA
CEMPAKA BALI GUEST Hous Tel.(62)361-53174 / 51517 Fax (62)361-54934 / 52777
E-Mail: purwa@denpasar.wasantara.net.id
30% DISCOUNT on US$ 45                                           10 Rooms
Airco,coffee machine,refrig.,satellite TV,priv.bath,toilet,verandah. Pool
Very nice for a long-stay guest. Use of car can be arranged.

Arrival Information:

Arrival Date
Arrival Time
Arriving from
Arriving by
Arriving by Flight Number: (Optional !)

Departure Information:

Departure Date
Departing to
Departing by
Departing by Flight Number: (Optional !)

Accommodation requested (1 ETN Card needed for EACH Room)

x Single Room (1 person)
x Double Room (2 persons)
x Triple Room (3 persons)
x Quad Room (4 persons)

Car Rental requested (1 ETN Card needed for EACH Car)

Car Group
Car Pick-Up at

Remarks, Comments and Questions

Use the space below to place special requests, provide additional information, or ask any questions. You'll be answered promptly.


Credit Card Information

If your estimated Arrival Time is after 16.00 hours (4 pm), your reservation can only be guaranteed upon receipt by the Hotel of a ONE NIGHT deposit before your arrival OR by completing your Credit Card Information below.

CEMPAKA BALI GUEST Hous realizes that you may not be very comfortable in sending your credit card info via Internet. That's why they advise you to send your card number in one of the following TWO ways:
  1. Send EACH block of 4 digits in REVERSE order !!
    EXAMPLE: Your credit card number is: 1234 5678 9123 4567
    Below you give your credit card number as: 4321 8765 3219 7654
  2. Send your credit card number by fax to: + (62)361-54934 / 52777

Inform how you send your credit card number:


Credit Card NUMBER 4 x 4 digits !
Expiration Date mm/yy
Name Card holder
Credit Card type