Chaweng Regent Resort - Credit Card Payment Form
To guarantee your booking, please printout this form, complete all the information
and fax to Chaweng Regent Resort   Fax (66 2) 541-9574
(The required amount to be paid is full payment of the first night of total booking)

I hereby authorized  CHAWENG REGENT RESORT SAMUI to charge

the amount of US$                                                                                          .

to my credit card for my accommodations from _____________ to:                        

Guests name :                                                                                              

Cardholder Name :                                                                                       

Credit card no. :                                                                                         

Master/VISA Card - the last 3 digits show on the back of the card :                      

AMEX - 4 digits code :                         Expiry date :                                

Card company :                                        Country:                                    

SIGNATURE : __________________________ Date : ____________________

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office
at (662) 541-9574 Attn. Miss.Varin E-mail : rsvn@asianetonline.com