NOVOTEL BANGKOK BANGNA
BILLING AUTHORIZATION FORM
Please complete the following form and fax it back to (66) 0 2366-0502 or Email: reservations@novotelbangkokbangna.com
I, ____________________________________ hereby authorized the Novotel Bangkok Bangna to charge
My credit card number _____________________________________________
Exp. Date ___________ Visa /Master American Express Other ____________
Please charge (select one):
( ) GUARANTEED PAYMENT ONLY
( ) ROOM AND BREAKFAST ONLY
( ) ALL EXPENSES
For charges incurred by Mr/Ms: _________________________________________________
(Enter name of guest)
FROM ______________________________ TO ___________________________ (enter dates)
FROM ______________________________ TO ___________________________ (enter dates)
Cardholder’s information:
Address: _________________________ Phone: ________________________
_________________________________ Fax: ________________________
_________________________________
_________________________________ Signature: ________________________
** We required a clear photocopy of the front and back of the credit card being used for the charges on this form.We suggest you set the copier on a light mode and enlarge it.