Golden Cupids Hotel, Chiang Mai, Thailand Credit Card Authorization Form/title> <meta name="keywords" content="Credit Card Authorization Form, Fax form, Golden Cupids Hotel, Golden Cupids Chiang Mai"> <style type="text/css" media="screen"></style> </head> <body background="picture/test1.gif" bgcolor="#fffacd" leftmargin="0" marginwidth="0" topmargin="0" marginheight="0"> <div align="center"> <table align="center" bgcolor="#fafad2" cool width="650" height="703" gridx="16" gridy="16" border="0" cellpadding="0" cellspacing="0"> <tr height="2"> <td width="649" height="2" colspan="10"><spacer type="block" width="649" height="2"></td> <td width="1" height="2"><spacer type="block" width="1" height="2"></td> </tr> <tr height="98"> <td width="253" height="98" colspan="5"><spacer type="block" width="253" height="98"></td> <td width="196" height="98" valign="top" align="left" xpos="253"><img src="botton/cupidbig.gif" alt="" height="90" width="143" border="0"></td> <td width="193" height="98" 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color="#000011" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Credit Cards Authorization Form</font></b></p> </div> </td> <td width="3" height="31"><spacer type="block" width="3" height="31"></td> <td width="1" height="31"><spacer type="block" width="1" height="31"></td> </tr> <tr height="474"> <td width="5" height="474" colspan="3"><spacer type="block" width="5" height="474"></td> <td content csheight="474" width="640" height="474" colspan="5" valign="top" xpos="5"><font size="2" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><b><font color="red">Please print out this form,</font></b></font><font size="2" color="#000011" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> fill it out completely all the information and fax to our Hotel at <b>(66)53 -844218. </b></font><font size="2" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Currently we accept <b>Visa, MasterCard and JCB cards subject to 3% surcharge</b>.</font> <div align="left"> <font size="2" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> <hr> I hereby authorize <b>Epic Enterprises Co., Ltd.</b> to charge deposit amount of<br> <br> Thai Baht ................................................................................................<br> <br> Cardholder's Name :...............................................................................<br> (as it appears on card)<br> <br> Guest's Name :........................................................................................<br> (if different from above)<br> <br> Card Number: ........................................................................................<br> <b><br> Please </b>write down the last 3 digits show on the back of the card:...................<br> <br> Expiry Date :...........................................................................................<br> <br> Card Company:......................................................................................<br> <br> Country:...................................................................................................<br> <br> <br> SIGNATURE:..........................................................................................<br> <br> Date: ........................................................................................................</font></div> <div align="center"> <p><font size="2" color="red" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">*************************IMPORTANT **********************</font><font size="2" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><br> Please kindly print this form, fill-in your detail and fax it back to <b>Golden Cupids Hotel at (66)53-844218</b>.</font></p> </div> </td> <td width="4" height="474" colspan="2"><spacer type="block" width="4" height="474"></td> <td width="1" height="474"><spacer type="block" width="1" height="474"></td> </tr> <tr height="1" cntrlrow> <td width="2" height="1"><spacer type="block" width="2" 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