BALI HAI CRUISES BOOKING FORM

Your Name*

Phone Number with Country Code*

Your Email*

Passport Number*

Number of Adults (14 years & over)*

Number of children (4-14 years)

Number of Infants (under 4 years)

Type of Ticket*

Date of Departure from Bali

Date of Departure from Lembongan

Pick up location in Bali*

Flight Number

Arrival Time

OR

Hotel / Villa Name & Address

Hotel / Villa Contact Number

Drop off location in Bali*

Flight Time

OR

Hotel / Villa Name & Address

Name of accommodation in Lembongan. Please put N/A if you are a day tripper.*

Please list names of all people travelling*

Message / Special Requests

How did you hear about us?*