CREDIT CARD FAX FORM- The Imperial Chiang Mai Resort

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 The Imperial Chiang Mai Resort Spa & Club 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 :                                                                                     

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