Asia Hotel Group-Credit Card Payment Form

---

To guarantee your booking, please print out this form, complete all the information and

fax to	Asia Hotel Bangkok	66-2-217-0808
	Asia Pattaya Hotel	66-38-250401-11
	Asia Airport Hotel	66-2-992-6999

(The required amount to be paid is full payment of the total booking)

I hereby authorized ---- select hotel name ---- ASIA HOTEL BANGKOK  ASIA PATTAYA HOTEL ASIA AIRPORT HOTEL

to charge my credit card for the accommodations

Date Check In  :       Date Check Out  :
Total Amount in Thai Baht :
Cardholder's Name	:	(as it appears on card)
Guest's Name	:	(if different from above)
Card company	: >------- SELECT CARD -------> VISA CARD MASTER CARD AMEX CARD JCB CARD
Card Number	:
Expiry date	: Country :

Please write down the the last 3 digits show on the back of the card :

Card company: