Salutation
Mr Mrs Miss
*First Name  
*Last Name  
Company / Organization  
Position / Title  
*Address  
*City  
State  
Zip / Postal Code  
*Country  
*Phone Number / Mobile Phone
Country Code
Area Code
Phone Number
   /  
Mobile Phone
Fax Number
Country Code
Area Code
Fax Number
E-mail address  
*Expected arrival date  DD      MM      YY  
*Length of stay Night(s) 
*Room / Cottage type
Room/Cottage Type No. of Rooms/
Cottages
*No. of adults Person(s) 
Bed type  
*Payment Method Cash     Credit Card  
**Credit Card Type  
**Credit Card Number  
**Credit Card Name  
**Credit Card Expired Date  DD      MM      YY 
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Additional comments/remarks
 
    
* required
** required if the payment method is Credit Card.



KARTIKA WIJAYA Batu Heritage Hotel
Jl. Panglima Sudirman 127, Batu, Jawa Timur
Tel : (62-0341) 592 600 (hunting) - Fax : (62-0341) 591 004
E-mail : hotinfo@kartikawijaya.com