member detail membership no. family name email re-enter email management fee Payment should be for the size of apartment specified on your Membership Certificate apartment size additional fees outstanding total Select Apartment Studio US$ 275 One Bed US$ 308 Two Bed US$ 363 Three Bed US$ 412 (if applicable) (USD) (USD) sales tax 10% total payable   (USD) (USD)   payment detail Please debit my credit card with the Total Payable. I understand that payment will be taken in Rupiah at the exchange rate current on the date of payment and a 3% service fee added.   card type card number Visa Mastercard expiry date card holder name Month January February March April May June July August September October November December   Year 2010201120122013201420152016201720182019   holiday choice I would like to holiday at Jimbaran Hills in 2009. My choice of dates (starting Saturday - dd/mm/yyyy) are:   1. 2. I would like to holiday at Jimbaran Hills Club in 2010. I will make my booking at a later date. Please deposit my entitlement with Dial an Exchange I will inform you later (please note we must be informed of any deposit request prior to the end of September 2009) additional comment  I have read and agree the Notes on Payment

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