ETN Hotel Reservation Form for
BALI PADMA HOTEL, DENPASAR,Bali

This Reservation Form is sent DIRECTLY to BALI PADMA HOTEL by E-Mail.
(NOT to the ETN Head Office, NOT to a travel agent or any other office)
BALI PADMA HOTEL will answer your request as soon as possible.
If your reservation is confirmed, BALI PADMA HOTEL 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 80361    DENPASAR,Bali      P.O.BOX 1107 TBB, 1 PADMA St,LEGIAN
BALI PADMA HOTEL        Tel.(62)361-752 111       Fax (62)361-75 2140/3623
E-Mail: padma@denpasar.wasantara.net.id
25% DISCOUNT on US$ 150-170 (Single: US$ 140-160)      DELUXE * 417 Rooms
24DEC-5JAN, JUL-AUG: 0% on US$ 185-205 (Single: US$ 175-195)
Located right on the Legian Beach.  380-Seat restaurant with Italian,
International, Asean, Japanese and Indonesian cuisine.
This property has the following Hotel (1-42) & Room (43-58) Facilities:
1-2-3-4-7-9-10-12-13-15-16-18-19-21-22-24-25-26-27-29-30-31-32-33-34-38
39-40-43-44-45-46-49-51-52-53-54-55-56-57-58

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.

BALI PADMA HOTEL 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)361-75 2140/3623

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