Airport Resort Credit Card Payment Authorization Form

Authorization for Payment by Credit Card
Phuket Airport Group Co., Ltd.
80/15 Moo 1 Sakoo, Thalang, Phuket 83110 Thailand
Tel: (66) 076.327.697 Fax: (66) 076.327.698 Email: info@phuketairportresort.com

After you complete this form, please print, then sign your name and FAX to Airport Resort.

	Name
	Passport or ID No.	Expiry Date
	Address
	Email Address

Telephone

Country Code

City Code

Number

PAYMENT DETAILS (Note: Payment Amount includes 7% VAT and handling fee.)
I authorize Phuket Airport Group Co. Ltd. to charge the amount NOT TO EXCEED .00 Baht
Same amount written in words .00 Baht

NUMBER on Credit Card

Expiry Date on Credit Card
3 or 4 digit authentication number on the back of the credit card

	Please provide the Correct Billing Information for this Credit Card
	NAME as printed on Credit Card
	Street Address
	City, State / Province
	Country & Postal Code

	Purchase Details
	Booking Number
	REFUNDS: 50% of booking amount for written/email cancellation less than 30 days prior to booking date. One night charge for written/email cancellation more than 30 days prior to booking date. PLEASE PRINT this form now, then sign below just like you sign your credit card. Fax this signed document directly to Airport Resort (66) 076.327.698. Keep this original document for your records.
	SIGNATURE (as used on card) ________________________________
	DATE _________/___________/_____
	Thank you for staying at Airport Resort