| Credit Card Authorization Form - Please Print Out
To reserve your room please complete the below Credit Card Authorization Form and fax it back to our address below. Please note that a certain deposit is required to hold your booking. Important: Please ensure that you receive confirmation by E-mail on your booking request prior to sending this Credit Card Authorization. PLEASE NOTE / BITTE BEACHTEN
3% surcharge will apply on credit cards
3% Aufschlag auf Kredit Karten Abbuchung
To: Toy Residence FAX NUMBER: +66-76-344870 |
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| From | ___________________________________ |
| Address | ___________________________________ |
| Tel | ___________________________________ |
| ___________________________________ | |
Credit Card Details |
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| Date | ___________________________________ |
| I, ____________________________ (Name) authorise Toy Residence to charge(amount)_____________ to my ( )Visa, ( )Master Card (please tick one) |
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| Cardholder's Name | ___________________________________ |
| Card Number | ___________________________________ |
| Expiry Date | ___________________________________ |
| Signature as on Card | ___________________________________ |
| Please include the complete number set of your credit card ( for Visa and Master card the last 3 digits ) | |