Spain Hotels
Credit Card Information Fax Form

Authorized by Asiavoyage Limited Partnership
 

Please Print this form, fill out completely and fax it to the following fax number:
Thailand :  +662 - 237- 4574  

Fax-in Payment

  Transaction Date :

Personal Particulars
 
Name:  ................................................................................................................ 
 
Telephone
 
:  ................................................................................................................
 
Email
 
:  ................................................................................................................

Payment Particulars
 

Credit Card Type

   VISA      MASTER      AMEX      DINERS CLUB
Credit Card Number 
:  ................................................................................................................
Secure Number
(The last 3 to 4 digit number
appearing on the signature panel)
 
:  ................................................................................................................

Card Holder's Name

 
:  ................................................................................................................

Expiry Date(MM/YYYY)

 
:  ................................................................................................................

Remark(s)

 
:  ................................................................................................................

 

 
   ................................................................................................................

Card Holder's Signature

 
:  ................................................................................................................

Booking Particulars
 
  Hotel Name :
 ................................................................................................................
Room Type
Check-In Date
(day/month/year)
Check-Out Date
(day/month/year)
 
 
  


 
  Guest Name :

 
I understand that Asia Voyage Limited Partnership will appear on my credit card statement for this transaction and that should I have any problems with this order, I can contact Asia Voyage Limited Partner for a prompt resolution by emailing info@spain-hotels-discount.com or calling 662-237-4577.