| CREDIT
CARD FAX FORM - U-THONG INN HOTEL |
| I hereby authorized U-THONG INN HOTEL, AYUTTHAYA to charge the amount of THAI BAHT .
from __ ___
to:
Cardholder's Name : (as it appears on card) Guest's Name : (if different from above) Card Number : Master Card : write down the last 3 digits show on the back of the card : AMEX : please inform Billing address 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
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