CREDIT CARD FAX FORM-CENTRAL SAMUI VILLAGE
To guarantee your booking, please printout this form, fill it out completely all the information
and fax to our reservations fax line Thailand : at (66 2) 541-9574
In case of no show, one night charge will be cherged through your credit card.
Currently we accept Only Visa, Master Amex or JCB cards.

I hereby authorized CENTRAL SAMUI VILLAGE, KOH-SAMUI   to charge the

amount of US$                                                                                  .

from __                           ___ to:                                      

Cardholder's Name :                                                          (as it appears on card)

Guest's Name :                                                                (if different from above)

Card Number :                                                                                     

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

Expiry date :                                     Card company :                                       

Country:                                               

SIGNATURE : _____________________ Date : ____________

*********************** IMPORTANT **********************

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office at
(66 2) 541-9574 Attn. Miss Varin E-mail :rsvn@asianetonline.com
Remarks : The charge will be exercised only in case of No-Show or cancellation less then 7 days
before arrival. If guests come to stay in the hotel, this charge will be cancelled and guests have to pay