Credit Card Payment FormPlease print out this form, then fill it out completely and fax it to Chiangmai-Guideline.com, (please also fax a photocopy of your passport - photo & signature pages). Fax Number: (++6653)296048 (if
you are outside of Thailand)
|
| I hereby authorise Chiangmai-Guideline.com
to charge the sum of
US$_______________ to my Visa [ ] Mastercard [ ] JCB [ ]
In payment of: Tour Services [ ] Accommodation [ ]
Hotel or Tour Service Dates: ____________________ Booking Number: ____________________ |
| Cardholder Name (exactly as it appears on the card) | |
| Card Number (ie. xxxx xxxx xxxx xxxx ) | |
| The last 3 Digit Number appearing on the signature panel | |
| Expiry Date ( MM/YY) | |
| Cardholder's Billing Address | |
| Cardholder's Passport Number & Nationality | |
| E Mail Address | |
| Telephone Number | |
| Fax Number | |
| Signature (as it appears on card) | |
| Date (of filling out & signing form) |
Print out this form, then fill it out completely and fax it to Chiangmai-Guideline.com. Please fax a photocopy of your passport (photo & signature pages) along with the form; Thai commercial banks require this documentation.
Our fax number is: +6653 296048 (outside
of Thailand)
(053) 296048 (within Thailand)
Payments are credited to our account in Thai Baht. You will be billed in your credit card statement, in your local currency. There might be slight price discrepancies according to the current exchange rate when the transaction takes place.
ChiangMai Guideline Travel : T.A.T Licence 23/0685