Flamingo Hotel

CREDIT CARD PAYMENT FORM

Credit Card Details:
FAX THIS FORM TO US AT (++66 38) 411521 TO SECURE THE RESERVATION

Type of card (VISA, MasterCard, American Express):................................................................... 

Name on card:..........................................................................................................................

Card number:......................................

Date of expiry:..................................................

Passport number: .........................................

Country:.................................................. 

Authorized signature..........................................................

Billing address .................................................................................................................

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American Express:
We also require the 4 digit number which appears above the card number

American Express 4 digit number:...........................