KOH NANG YUAN DIVE RESORT
RESERVATION FORM - Prepayment
PERSONAL INFORMATION
Mr. Mrs. Miss
First Name : Last Name :
Email_Address 1: ( Correspondence E-mail address) *required
Important!! Pls furnish complete email address so that our reply could reach you.
Email-Address 2 : ( Second e-mail address,if any or Reconfirm)
Telephone_number : Fax_number :
Company Name (if applicable) :
Country : Nationality :
RESERVATION DETAILS
Types of room(s) Required : *required
Number of room(s) required : Number of Person(s) required : Extra Bed : Yes No
Number of Children ( if any ) : Age of Children :
Indicate here if more than 1 type of rooms are required
Please also furnish names of the guests for the additional rooms
Date of check in : Date of check out:
FLIGHT INFORMATION   
Flight name and no. (Arrival) : Time of Arrival :
Flight name and no.(Departure) :Time of Departure :
Please indicate if airport pick up Service is required : Yes No
Indicate here for any special request
Please take a moment to let us know from where you get to know our site:
  
To payment your reservation, please print out this form and fill in all the information required with your signature and fax this form to +662 541-9574

Remark:  For further information please contact us at Contact e-mail : rsvn@asianetonline.com

Koh Nang Yuan Dive Resortl, Surathani