Bali Shopping Safaris > Booking Form

Booking Form

Click here for our terms and conditions.

To make a booking please fill in the form below.

Contact details
Please make sure that your name is exactly the same as it appears on your passport.
Name
Address
Email
Mobile
Home
Passport Details
Passport number
Nationality
Date of birth
Date of issue
Date of expiry
There must be at least six months until the expiry on your passport from the day of arrival in Indonesia.
Next of kin details
Name
Relationship
Address
Email
Mobile
Home phone
Other information
Please list below any special dietary requirements for meals onboard the flight.
Special dietary requirements
Air New Zealand Airpoints Number
Please list below any medical conditions that will affect Travel Insurance. If you are concerned about travelling please check with your Doctor first. Please be aware that there are no vaccinations required to visit Bali.
Medical conditions
	By ticking this box, I agree to the Terms and Conditions
Once you click on the submit button, your booking will be forwarded to New Zealand Travel Brokers who will contact you as to how you wish to pay the deposit.

Contact details
Please make sure that your name is exactly the same as it appears on your passport.
Name

Address

Email

Mobile

Home

Passport Details
Passport number

Nationality

Date of birth

Date of issue

Date of expiry

There must be at least six months until the expiry on your passport from the day of arrival in Indonesia.
Next of kin details
Name

Relationship

Address

Email

Mobile

Home phone

Other information
Please list below any special dietary requirements for meals onboard the flight.
Special dietary requirements

Air New Zealand Airpoints Number

Please list below any medical conditions that will affect Travel Insurance. If you are concerned about travelling please check with your Doctor first. Please be aware that there are no vaccinations required to visit Bali.
Medical conditions


By ticking this box, I agree to the Terms and Conditions
Once you click on the submit button, your booking will be forwarded to New Zealand Travel Brokers who will contact you as to how you wish to pay the deposit.