Different Bali Indonesia - Customized Tours Submission Form

( Free Estimate )

Section 1. Personal Information
Salutation
First Name
Last Name
Postal Address		(civic number, street, city, state or province)
Country
Phone number (with area code)
E-mail Address		( e.g. : name@domain.com )

Section 2. General information about the project
Number of Participants
Number of Adult
Adult Ages		( ex : 13, 20, 33, 40,...)
Number of children (Under 12 Years Old)		(civic number, street, city, state or province)
Children ages		( ex : 12, 6,...)
Entry Date		mm dd yyyy
Entry City
Duration of travel		day(s)
Exit City
Destinations
Java (must precise)
Bali :		Yes No
Lombok :		Yes No
Gili's island :		Yes No
Nusa Lembongan island		Yes No

Section 3. Kind of customized tour
What kind of customized tour would you like ?
Type of travel project
Do you want your trip to be :		Highly active Moderate active Relaxing
During your trip you wish to change hotel :		Often Sometimes Never )
Free Programs: If you wish days of total freedom, you want them:
With driver / guide and car at arrangement.
Number of days to foresee
Without car nor driver / guide (independent arrangement).
Number of days to be foreseen
You wish your guide speak

Section 4. Hotel Choice

Number of double rooms to foresee

Number of single rooms to foresee

What kind of accommodation would you like to stay in?

Section 5. Activity Choice

Indicate us your activities preferences in which you wish to participate

Cultural activities	Small priority	Medium priority	High priority
• Traditional festivities
• Cock fights
• Traditional dance and music "shows"
• Museum and art galleries
• Handy craft workshops
• Royal palaces
• Spiritual and worship monuments
• Traditional markets

Meet with cultural figures	Small priority	Medium priority	High priority
• Get introduce to a traditional healers
• Get introduce to local artists

Nature and adventure	Small priority	Medium priority	High priority
• Volcano climbing
• Countryside walks
• Trekking
• Cycling
• Rafting
• Fishing trips
• Natural parks
• Mountain and rice fields
• Speleology
• Ecotourism

Body and soul	Small priority	Medium priority	High priority
• Traditional massage
• Reflexology and shiatsu
• Body treatments
• Hot springs
• Meditation

Sports	Small priority	Medium priority	High priority
• Diving / snorkling
• Rafting
• Trekking
• Surf / bodysurf
• Golf
• Horse ridding

Leisure	Small priority	Medium priority	High priority
• Shopping
• Nightlife
• Beach and sea
• Dining
• Thematic parks

Course	Small priority	Medium priority	High priority
• Cooking lesson
• Massage lesson
• Dancing lesson

Section 6. Additional Information

This journey is due to the fact (honeymoon, birthday celebration, first stay abroad, for feeling a dream, a special occasion to revitalise) :

Have you been in Indonesia before?

Yes No

The region that you have been visited in Indonesia

If you wish to include further comment

You knew our site by the intermediary:

Of a Search engine

Of the link of another site, in that case which: or other one

Of an appearance

Of a friend which advised it to you

Other, clarify:

I have read the terms and conditions and I accept them. (This box must be checked)