Bangkok City Suite
SECURED RESERVATION

PERSONAL INFORMATION
Title :
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)
Second E-mail Address : (Second E-mail address,if any)
Telephone No :
Fax No :
Company Name : (If applicable)
Correspondence Address :
Nationality : *
RESERVATION DETAILS
Types of Promotion or Package Required :
Types of Rooms Required :
Types of Bed :
Number of Rooms Required :
Number of Adults occupying room :
Extra Bed ( if required ) : Yes No
Number of Children ( if any ) :
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
Flight Name and No. (Arrival) : Time of Arrival :
Flight Name and No.(Departure) : Time of Departure :
Please indicate if airport pick up Service is required : Yes No
CREDIT CARD DETAILS
All Credit Card Information is Encrypted for Privacy over the Internet
Credit Card Holder Name : *
Credit Card Type : *
Credit Card Number : *
* Card Identity Number : *
* (The last 3-digit number on the back of your Visa Card/Master Card/JCB Card, or the last 4-digit number on the front of Amex Card.)
Credit Card Expiration Date : * (month/year, example 12/2008)
Card Issuance Country : *
Card Issuance Bank : *
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