I hereby authorized Oriental Bangkok 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 :
*********************** 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