JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Balinese Salon Sasebo
Online reservation request is not guarantee of availability. We will contact you shortly.
* Indicates required question
Email
*
Your email
Mr
Ms
Name
Your answer
Last Name
Your answer
Phone
*
Your answer
E-mail
*
Your answer
When is your first choice?
*
MM
/
DD
/
YYYY
When is your second choice?
*
MM
/
DD
/
YYYY
Prefered Time
Time
:
AM
PM
Number of Guest(s)
*
1 male
2 male
1 female
2 female
1 male and 1 female
other
Required
(Please fill in only when using by two people.)
Would you like to get a massage together in one room or separate rooms?
Room together
Separate rooms
Either is fine
What course do you want to book?
*
60-minute course (weekdays only)
90-minute course
120-minute course
150-minute course
Required
How does it come?
*
car
taxi
walking
other
Required
Do you have any questions?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
