3D2N Bangkok Leisure Land Package

RESERVATION FORM

PERSONAL INFORMATION
IMPORTANT!! Pls make sure that it is the name shown on your passport. (*) is a compulsory field.
Title
Given 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 )
Telephone No
Fax No
Company Name (If applicable)
Correspondence Address
Country of Residing
Nationality
*
RESERVATION DETAILS

1st Choice of Hotel

2nd Choice of Hotel
Types of Rooms Required:
Number of Adult
Number of Rooms Required:
Date of Check-in (dd/mm/yyyy)
Date of Check-out (dd/mm/yyyy)
Arrival Flight * for pick up purpose
Arrrival Time * for pick up purpose
Departure Flight * for pick up purpose
Departure Time * for pick up purpose
Special Request
No
Name
Gender
Nationality
Date of Birth
Passport/IC No
Passport Expiry Date
1.
2.
3.
4.
5.
6.
7.
8.
Credit Card Details
* Please provide full credit card details in order to have priority in booking process and cardholder must be one of the travelling party.
Credit Card Holder Name *
Credit Card Type *
Credit Card Number *
Security Code
* The last 3-digit number on the back of your Visa Card/Master Card, or the last 4-digit number on the front of Amex Card
Credit Card Expiry Date
(month/year, example 12/09) *
Credit Card Issuing Bank
*
Credit Card Issuing Country
*
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