Inquiry Form - pertiwi resort Information Room Rates Name (*) Email Address (*) Address (Street, City, State) Country (*) Phone Arrival Date (date-month-year) Departure Date (date-month-year)     Arrival By (Flight) Departure By (Flight) # of Adults (*) # of Children (Age 2-12) # of Infants (Age 0-2) Room Type (Standard, Superior, Deluxe, etc) (*) Room Category (Sgl/Dbl/Twin) (*) # of Rooms Extra Bed Meals Arrival Transfer to Hotel Yes No Departure Transfer to Airport Yes No Other Services Please describe your inquiries/special request in details Please Type the code shown   (*) Required

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