Bill Orchardz Hotel Jakarta

Folio Number Name Contact Address Mahmud Rt. 01 City/State

: : :

08912 Taufik Afdal, Mr 085765648325 : Jl. Sultan

:

Rw. 04 No. 20 Tanjungpinang INA

Pax Payment Room Number Room Rate Arrival Date Departure Date

: : : : : :

2 CS #4123 Rp. 550,000 28-Nov-2013 29-Nov-2013 User ID

:KARTIKA Date Credits 28-Nov

Transaction

Room Charge Service Charge Room Tax Room 29-Nov Deposit Cash 1,100,000.00

Description

Room Charge 28 – 29 Nov Service Charge Room Tax DPST #4123 – 2 N

Charges

Room #4123 – 2 N Room #4123 Room #4123 1,300,000.00

Balance

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I AGREE THAT MY LIABILITY FOR THIS BILL IS NOT WAIVED AND AGREED TO BE HELD PERSONALLY LIABLE IN THE EVENT THAT THE INDICATED PERSON, COMPANY OR ASSOCIATION FAILS TO PAY ANY PART OR THE FULL AMOUNT OF THESE CHARGES

1,100,000.00

(200,000,00)

SIGNATURE :

Jalan Industri Raya No. 8 Gunung Sahari Jakarta 10720, Tel: (62-21) 6231 7788 (Hunting), Fax: (62-21) 6231 7799 Website: www.orchadshotel.com