LIMA COCO RESORT, Samet Island
RESERVATION FORM
PERSONAL INFORMATION
Mr. Mrs. Miss
First Name : Last Name :
Email_Address 1: ( Correspondence E-mail address) *required
Email-Address 2 : ( Second e-mail address,if any or Reconfirm)
Telephone_number : Fax_number :
Company Name (if applicable) :
Country : Nationality :
Important!! Pls furnish complete email address so that our reply could reach you
RESERVATION DETAILS
Types of room(s) Required : *required
Number of room(s) required : Number of Person(s) required :
Extra Bed : Yes No ( if required )
Number of Children ( if any ) : Age of Children :
Indicate here if more than 1 type of rooms are required
Please also furnish names of the guests for the additional rooms
Date of check in : Date of check out:
FLIGHT INFORMATION
Flight name and no. (Arrival) : Time of Arrival :
Flight name and no.(Departure) :Time of Departure :

Airport Transfer Requires click here for more info.

Indicate here for any special request
Please take a moment to let us know from where you get to know our site:
  
To payment your reservation, please print out this form and fill in all the information required with your signature and fax this form to +662 541-9574

Remark:

You will be informed of the status of your reservation within 24 hours after this form has been submitted. Thank you and we wish you a pleasant journey.
For further information please contact us at Contact e-mail : rsvn@asianetonline.com