Payment Confirmation

Hotel Room

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Organic Farm

Payment Confirmation Form

	Silahkan mengirimkan bukti transfer anda menggunakan menu di bawah ini. Kami akan segera melakukan konfirmasi, apabila pembayaran anda telah kami terima.
	CONTACT DETAIL
First Name (*)	Please fill in your first name
Last Name (*)	Please fill in your last name
Mobile Phone (*)	Please fill in your mobile phone number
Telephone / fax (*)	Please fill in your telephone/fax number
Address (*)	Please fill in your address
Your Email (*)	Please let us know your email address.
	PAYMENT INFO
Methode of Payment (*)	To Bank BCA To Bank Mandiri Choose your payment methode
Payment For (please fill in your confirmation number)	Please fill in your confirmation number
Account Number (*)	Please fill in your account number
Account Name (*)	Please fill in your account holder name
Bank (*)	Please fill in your bank name
Date of payment (*)	Please fill in your date of payment
Upload your scan of transfer payment	Maximum file size 500 KB
or Fill in your Transfer Note	Invalid Input
Please Click Button to Submit
	Payment by transfer should be adressed to: Bank BCA No acct # 7310 28 2001 a/n. Mira Dewanti Bank Mandiri No acct # 133 00 1136 3157 a/n. Mira Dewanti
	Note : Rows with (*) code, should be filled in completely..!


	Bank BCA No acct # 7310 28 2001 a/n. Mira Dewanti

	Bank Mandiri No acct # 133 00 1136 3157 a/n. Mira Dewanti

	Untuk melakukan pemesanan online silahkan mengirimkan email melalui menu HUBUNGI KAMI, whatsapp ke MUFTY SULTHONY 0821 3039 8922 atau langsung click menu di bawah ini:

	1. ONLINE RESERVATION
	Setelah anda mendapatkan konfirmasi dari kami atas pemesanan online anda, kirimkanlah bukti pembayaran melalui menu di bawah ini :
	2. BUKTI TRANSFER
	Isikan validasi transfer anda atau upload scan bukti transfer anda.