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Credit Card Authorization Fax Form

Please print this from, fill it out completely and elaborately, and send it
By fax to Thailand 662-186-3186
I ____________________________ (Your name) authorize a charge
Of __________________________ (Fill in amount)
Credit Card Type: ___________________________
To my Master Card Visa

Reservation Number:
Cardholder's Name:
(As it appears on card)
Guest's Name:
(If different from above)
Departure/Check In Date:
Return/Check Out Date:
Bank Issuer's Name:
City & Country Issued:  
E-Mail Address / Telephone:
Credit Card Number:
Expiration Date:
(MM/YY) 		 
Security verification code:
(3-4 digits, see location on the right)
Signature of Card Holder:


** I understand that the services, for which Next Level Co., Ltd. Will charge my credit card for, may not be refundable and there may be penalties for changes. By Signing on this document, I also acknowledge that I understand, abide by, and agree to all term of purchase.
Fraud Prevention Information
The card Identification Number (Card ID) is required for Visa and MasterCard. The Card ID is an added security feature to help protect you against online fraud.

Visa Card
Last 3 digits on back of card		    Master Card
   Last 3 digits on back of card
Mooban Supalai Ville 5/200, Moo 2, Sukhumvit Rd, Tambol Samrongnua, Amphur Muang Samutprakarn, samutprakarn 10270
Tel. 662-186-3186, Fax. 662-186-3182 TAT TRAVEL LICENSE NO.11/3380
All requests for cancellation must be sent directly to us by e-mail at:sale@thailandehotel.com of fax to (662)186-3186