CREDIT CARD AUTHORISATION
Please fax to +66 2 2253861 or +66 2 224 8248
NAME OF AUTHORISATION: Tanet phanichewa……………………………………………………………….
BILLING ADDRESS: ……356 yannawa bangkok…………………………………………………………
I…………………………… hereby authorise CHAKRABONGSE VILLAS LTD.
on …3/9/2014…………………… (DATE) to charge ……9,000…………………. (TOTAL AMOUNT)
in payment of (ROOM / DINNER / FUNCTION) RESERVATIONS
…………………Dinner…………………………………………………………………………..
Card Type:…………Master card…………………………………………………………….
Visa/Master Card no: ………………………………..…………..…………………
Name: ………Tanet phanichewa…………………… ………………...……………..........................
Exp: ………06/17………………………………….........................................................
CVC (3 digit security code on signature strip):…….……………………………..
……………………………………………. ………………………..
Signature of card holder Date
Mailing Address: Chakrabongse Villas Ltd. 396/1 Maharaj Rd,
Phraborommaharajawang, Pranakorn, Bangkok 10200 Thailand
Tel: +66 2 222 1290 Fax: +66 2 225 3861/+66 2 224 8248
email: reservation@