This is to authorise for online payment submit.
Unity Power Service Co.,Ltd.
848/2 Ladkrabang Rd, Ladkrabang, Bangkok 10520
Tel: +662 326 6427, +662 327 0496, +668 6332 0736 Fax: +662 327 0495
Please Fill Up this form and Fax to Bangkok Office +662 327 0496
Arrival Date: ________________________ Departure Date:___________________________
Guest Name: __________________________________________________________________
( same name on Booking )
Cardholder's Name:____________________________________________________________
(same name Booking & Your Credit Card)
Visa Card Number: ___________________________________ Security Code________
Master Card Number:_________________________________ Security Code________
(Security is 3 or 6 digit number that is print on the back of Credit Card)
Credit Card Expire Date: _______________________________________________________
I hereby authorize a charge of Amount and Currency below.
US-Dollar:___________________________ Thai-Baht: _______________________________
Amount in Letter : _____________________________________________________________
Payment Of : __________________________________________________________
( Hotel ,Package Tour , Air-Ticket, Transportation, etc., )
Cardholder's Billing Address & Street:___________________________________________
_____________________________________________________________________________
Country: __________________________________________Zip Code : __________________
Area Code: ___________ Tel: _______________________ Fax:_______________________
E-Mail Address : _____________________________________________( Important )
Signature: __________________________________________________ Date:____________
( same signature on Your Credit Card )
Thailand's Nation-Wide-Hotel & Resort-Booking / save up to 75% of Hotel Rates.
Please contact us if you do not receive confirmation-mail within 6 hours
please email to E-mail contact@unitypowerservice.com
www.unitypowerservice.com
|