Credit Form

Hotel Online - Credit Card Payment Form

To guarantee your booking, please printout this form, complete all the information and fax to

Hotel Online Fax (662) 281-4188
(The required amount to be paid is full payment of the first night of total booking)

Hotel name                                                                                                                                     .

I here by authorized                                                                                       to charge the amount of

Thai Baht                                                                                                                                      .

to my credit card for my accommodations from __________________ to:

Name : Country:

Credit card company :

Credit card no. Expiry date :

SIGNATURE : _______________________________ Date : .