CREDIT CARD FAX FORM- LOMA HOTEL PATTAYA
To guarantee your booking, please printout this form, fill it out completely all the information and fax to our reservations fax line Thailand : at +66 0 3842-1501 ( In case of no show, one night charge will be cherged through your credit card ) . Currently we accept Only Visa, Master Amex or JCB cards. )

I hereby authorized   to charge the LOMA HOTEL ,PATTAYA

amount of Thai Baht                                                                                          

Date check in:                                      check out :                                             

Cardholder's Name :                                                             (as it appears on card)

Guest's Name :                                                                    (if different from above)

Card Number :                                                                                   

Master Card : write down the last 3 digits show on the back of the card :               

AMEX : please inform Billing address                                                                      

Expiry date :                                     Card company :                                      

Country:                                                      

SIGNATURE : _____________________________ Date : _________       _________

*********************** IMPORTANT **********************

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office at
+66 0 38452 1501 Attn: Miss Kaewmanee E-mail :rsvn@lomahotel.com
Remarks : The charge will be exercised only in case of No-Show or cancellation less
then 48 hours before arrival. If guests come to stay in the hotel, this charge will be
cancelled and guests have to pay in full amount at the hotel.