Booking Details - Bali Takeover

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First Name

Last Name

Mobile Number

Where are you travelling from?

How many people are traveling in your party?

Guest No.4 Email

Guest No.3 Email

Guest No.2 Email

Room Option

🚨 IMPORTANT: Please confirm the dates of your package:

Payment Plan Details

In order to pay off the remaining balance of the package, an automated payment plan will be set up following payment of the deposit to ensure it is paid off on time, this can be amended or cancelled at any time by emailing accounts@qo5iwci2et.wpdns.site. Please select the following options below, payment plans can be amended via email.

How would you like to pay off your package?

In full (shared room) - $1899 / £999 In full (own room) - $2229 / £1149 Weekly - $100 / £50 Monthly - $300 / £150

Billing Address

Street Address

City

State

Post/Zip Code

Start my payments from:

Payment Details

Name On Card

You are applying to be part of a party group in Bali, Indonesia. By ticking the box below you are confirming that you will be over the age of 20 by the date of departure and that you agree to our terms and conditions.

I agree to all the terms and conditions and confirm that I will be over the age of 20 by the date of departure.

Please wait up to 60 seconds after you submit this form before clicking off the page. As we have a high volume of people booking at the same time, the site will be slower than usual

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