We need the following information to confirm your reservation:
Title:
Mr.
Mrs.
Ms.
Name *:
Surname *:
Company Name:
Address:
Post/Zip code:
City:
State:
Country:
ANDORRA
ANGOLA
ARGELIA
ARGENTINA
ASIAN
AUSTRALIA
AUSTRIA
BAHAMAS
BANGLADESH
BARBADOS
BELGIUM
BELIZE
BERMUDAS
BHUTAN
BOLIVIA
BOSNIA Y HERZEG
BRAZIL
BRITSH WEST IND
BRUNEI DARUSSAL
BULGARIA
CANADA
CAPE GREEN REPU
CHILE
CHINA
COLOMBIA
COSTA RICA
CROACIA
CUBA
CYPRUS
DENMARK
DOMINICAN REPUB
ECUADOR
EGYPT
EL SALVADOR
EUROPEAN
FIJI
FINLAND
FRANCE
GABON
GERMANY
GIBRALTAR
GREAT BRITAIN
GREECE
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HAITI
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ICELAND
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IRAK
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ISRAEL
ITALY
IVORY COAST
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LATVIA (LETONIA
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MACEDONIA
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MALTA
MARTINICA (DPT.
MAURITANIA
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MONACO
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NETHERLAND ANTI
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NIGER
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OMAN
PAKISTAN
PANAMA
PAPUA - NUEVA G
PARAGUAY
PERU
PHILIPPINES
POLAND
POPULAR REP. OF
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF BEL
REPUBLIC OF KOR
RUMANIA
RUSSIA
SAN MARINO
SAUDI ARABIA
SENEGAL
SINGAPORE
SLOVAKIA
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SPAIN
SRI LANKA
STONIA
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
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THE CZECH REPUB
TRINIDAD & TOBA
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UNITED ARAB EMI
UNITED STATES
URUGUAY
VARIOUS
VENEZUELA
VIETNAM
YUGOSLAVIA
Telephone *:
Fax:
E-mail *:
Arrival Date
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02
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31
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
Departure Date
01
02
03
04
05
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31
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
Room or Suites Type
Deluxe Room
Super Deluxe Room
Royal Service Room
Junior Suites
Royal Service Suites
Deluxe Suites
Executive Suites
Presidential Suites
Extra Bed
Number of Night
1
2
3
4
5
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9
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11
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15
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28
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30
night
Please, type in this box any additional
information or requests you would like
forwarded to the hotel:
* Obligatory
Jalan H.R. Rasuna Said Kav. X-O, Kuningan,
Jakarta 12950 Indonesia
Tel : (62-21) 5268080, Fax : (62-21) 5268181,
e-mail :
info@granmeliajakarta.com