(The
required amount to be paid is full payment of the first night of total booking)
I
hereby authorized LOMA HOTEL PATTAYA
to charge
the
amount
of
to my credit
card for my accommodations from __________________
to:
Guests name
:
Card Holder
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 : _____________________
***********************
IMPORTANT **********************
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