Hotel LogoCREDIT CARD PAYMENT AUTHORIZATION

(please indicate currency)

(in letters)

TO:

Card Number : - - - Expiry Date:

My name as appear on the card is :

The above mentioned charge is for :

Card Holder's Signature :

Date:

Cardholder's Passport No :

Cardholder's Address :

Cardholder's Tel. No : Country Code No

Cardholder's Fax No : Country Code No

1)

2) Print out the form and verify that all details are correct, then please sign your name on the "Card Holder's Signature" line3) Fax authorization form, along with copy of the credit card on both sides to Reservation Dept at Telp: (000) 00000004) Please also fax a copy of your passport (the page with picture and passport holder information)

American Express Visa and Master Card

I, authorize _________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________

to charge the sum of :

Please fill in the last three-digit number (for VISA card) or four digit number (for AMEX) appearing on signature panel: (see example)

Instructions on How to Use This Form:Kindly fill your credit card type, card number, name on card, expiry date, plus the last 3 or 4 digits on the back of your card (depending on your card type)

AmexVisa Master Card JCBDiscover Diners Club

4 digits on front of card last 3 digits on back of card

The card Identification Number (Card ID) is required for American Express, Visa and Mastercard. The Card ID is an added security feature to help protect you against online fraud.