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Please print out this form, fill it out completely all the information and fax to our Hotel at (66)53 -844218. Currently we accept Visa, MasterCard and JCB cards subject to 3% surcharge.
I hereby authorize Epic Enterprises Co., Ltd. to charge deposit amount of
Thai Baht ................................................................................................
Cardholder's Name :...............................................................................
(as it appears on card)
Guest's Name :........................................................................................
(if different from above)
Card Number: ........................................................................................
Please write down the last 3 digits show on the back of the card:...................
Expiry Date :...........................................................................................
Card Company:......................................................................................
Country:...................................................................................................
SIGNATURE:..........................................................................................
Date: ........................................................................................................
*************************IMPORTANT **********************
Please kindly print this form, fill-in your detail and fax it back to Golden Cupids Hotel at (66)53-844218.
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