(The required amount to be paid is full payment of the first night of total booking)

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I hereby authorized MONTIEN PATTAYA HOTEL to charge

the amount of                                                                   

to my credit card for my accommodations from __________________

to:                                

Guests name :                                                                         

Card Holder Name :                                                                  

Country:                                                       

Against Credit card [ VISA, MASTER or JCB] :                               

Credit card no.                                                                       

Expiry date :                                              

SIGNATURE : ___________________________ Date :                         

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