Switzerlandhotel.net
Credit Card Information Fax Form
Authorized by Well Booking Company Limited
 

Please Print this form, fill out completely and fax it to the following fax number:
Thailand :  +662 - 992 5889

Fax-in Payment

   Transaction Date :

Personal Particulars
 
Name :  ................................................................................................................ 
 
Telephone 		 
:  ................................................................................................................
 
Email		  
:  ................................................................................................................

Payment Particulars
 

Credit Card Type

   VISA      MASTER      AMEX      DINERS CLUB
Credit Card Number  
:  ................................................................................................................
Secure Number
(The last 3 to 4 digit number
appearing on the signature panel)		  
:  ................................................................................................................

Card Holder's Name

 
:  ................................................................................................................

Expiry Date(MM/YYYY)

 
:  ................................................................................................................

Remark(s)

 
:  ................................................................................................................

 

  
   ................................................................................................................

Card Holder's Signature

 
:  ................................................................................................................

Booking Particulars
 
  Hotel Name :  ................................................................................................................
Room Type
Check-In Date
(day/month/year)
Check-Out Date
(day/month/year)
 
 		    


 
  Guest Name :

 
I understand that Well Booking Company Limited will appear on my credit card statement for this transaction and that should I have any problems with this order, I can contact Well Booking Company Limited for a prompt resolution by emailing info@switzerlandhotel.net or calling 662-992-5884.