CREDIT CARD
PAYMENT FORM Please debit the total amount...............................................................USD Against Credit Card : .[ VISA, MASTER, AMEX ONLY, ] Please circle..................... Credit Card No. ......................................................................................... Credit Card Bank:....................................................................................... Cardholder Name : .................................................................................... Billing Address: ......................................................................................... Expiry date : ............................................................................................. Please advise the last three-digit number appearing on signature panel (if any) : ........................................................................................ (See example) For payment of booking/invoice number: ...................................................... or Hotel name : ........................................................................................ Guest name : ............................................................................................. E-mail address : ......................................................................................... Cardholder's passport number :.........................................Expire date........... Signature of Cardholder : ............................................................................ Date : ....................................................................................................... *********************** IMPORTANT ************************ Please kindly print this form, fill-in your details and fax it back to our Hanoi Office at ++84.4. 9274118 Attention Reservation Department Address: 05 Nguyen Truong To Str, Ba Dinh Dist. Hanoi, Vietnam Opening Hours: Phone: ++84.4.9274120 Fax: ++84.4.9274118 Hotline:++84.91.2303096 |