Credit Card Authorization Form

Viangbua Mansion Serviced Apartment Credit Card Information Fax Form

Please print this form, fill it out completely, and fax it to these numbers: For Oversea ( USA / Europe and others ) Fax: ++ (053) 411 224  ( these code might differs from countries to countries, please check with you local telecommunication if the fax cannot goes through ) From Thailand : Fax: 053-411224 I hereby authorize a charge of  Baht _________   ( Thai Baht ) to my  (Visa)  (MasterCard). (Current exchange rate = USD 100 = 4,100 Bahts ). Please be inform that 5% authorization service charges applied. Fax sent will be immediately forwarded to our Reservation Center.  Please contact us if you do not receive confirmation of our receipt of this fax form within 48 hours of sending it.

Cardholder's Name: (as it appears on card)
Guest's Name: (if different from above)
Card Number:
Expiration Date- ( Month / Year ) :		VISA  or MASTERCARD
Cardholder's Address:
Passport Number:
E-Mail Address:
Telephone / Fax:
Your Booking / Reservation Type of Room / Date/ Duration
Booking Code or Reference (if any) :
Authorization Code :	To be filled up by viangbua mansion management.
Signature: (I the cardholder hereby authorize this charge to my credit card for the room reservation detailed above made under the name of the guest indicated above.)

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Reservation : reservation@viangbuamansion-chiangmai.com

"welcome to stay with us and experience a contemporary Thai-Lanna style in our serviced apartment - Viangbua Mansion"

For more detail about viangbua mansion, room rental rates and services, kindly click this links:

Viangbua Mansion Serviced Apartment - Type Of Room & Rates