PERSONAL INFORMATION
IMPORTANT!! Pls furnish full name. Names furnished here will be the names used to register for the rooms.
Title Name 1: Mr. Mrs. Miss	First Name :	Family Name :
Title Name 2: Mr. Mrs. Miss	First Name :	Family Name :
Title Name 3: Mr. Mrs. Miss	First Name :	Family Name :

IMPORTANT!!Pls furnish complete e-mail address so that our reply could reach you
E-mail Address :	* (Correspondence E-mail address)
E-mail Address :	(Second E-mail address, if any)
Fax No:
Telephone No :
Company Name (if applicable) :
Correspondence Address :
Country :
Nationality :	*

RESERVATION DETAILS
Hotel Name :	Please Select Burasari Resort Dusit Thani Laguna Phuket Patong Resort Royal Paradise Hotel Thara Patong Resort & Spa
Types of Bed:	Please Select Single (a person in a room) Twin (2 persons in separate beds) Double (2 persons in queen/king bed) Triple (3 persons with an extra bed)
Number of Rooms Required:	1 2 3 4 5 6
Number of Adults occupying room :
Extra Bed (if required) :	Yes No
Number of Children (if any) :	0 1 2 3 4 5
Age of Children :
Indicate here if more than 1 type of rooms are required. Please also furnish names of the guests for the additional rooms
Indicate here for any special request (bed types preferred, connecting room, etc.)
Date of Check In : Date of Check Out:

FLIGHT INFORMATION

Departure Flight Time From Bangkok :

Flight Time Departure from Phuket :

Preferred payment method: Pls select By Visa Card By Master Card By JCB Card By AMEX By Telegraphic Transfer

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