Bali Escape 2.0

Step 1: Guest Information

Where did you first hear about us?

Total Number of Guests:

Guests 1 Information - If we are making an air reservation, Guest name MUST match passport exactly in order to board airplane.

Guest Title :

First Name *:

Middle Name :

Last Name *:

Guest DOB*:

Please provide a valid date in the "MM/DD/YYYY" format

Gender :

Step 2: Contact Information Click here to give us more info...

Street Address *:

City *:

Whose address is this? :

Email Address * :

Email Address 2 :

Phone Number *:

Phone Number 2 * :

Step 3: Trip Information Click here to give us more info...

Departure Date *:

Please provide a valid date in the "MM/DD/YYYY" format

Return Date *:

Please provide a valid date in the "MM/DD/YYYY" format

Room/Cabin Type * :

Bedding Type :

Departure Airport :

You can follow the link below to add insurance. However, you can add our traditional insurance at a later date. https://partner.roamright.com/?AgencyCode=skyreeltravels

Step 4: Payment Information (optional) Click here to give us more info...

Payment Type :

Submit an additional payment type: Yes No

Step 5: Additional Information Click here to give us more info...

Special Requests :

Other Questions/Comments :

By submitting, you certify that you are the cardholder and are authorizing SkyReel Travels or its chosen Tour Operator/Supplier/Cruise Line to charge the listed amount to the credit card. You certify that you have verified that all information contained in the confirmation you received is accurate. You also certify you have read the Terms & Conditions and the appropriate Travel Protection Plan details. Cancellation penalties may apply. Insurance is not refundable. This charge will be manually applied by the agency to your reservation. If there are any issues, an agent will get back to you. Please note that you may not see a charge from the travel agency on your credit card statement; the charge will come from our supplier and/or the airline directly. Payment may take 3-5 business days to fully process and be reflected on your statement. I authorize SkyReel Travels to use the above information to charge my credit card the stated amount. Completion of this form and the initialing of this box signifies acceptance in lieu of my signature.By checking the box below and adding your signature, you indicate that the above amount is correct, you authorize the travel agency to charge your credit card for the specified amount, and you agree to the terms and conditions.

I Agree *