Credit Card Authorisation Form - by Fax
Please print this form, fill it out completely, and fax it back to us.
 
Fax No. + 66 2 254 6079
 
I wish to pay by :
AMEX VISA MASTER JCB
 
I hereby authorise ULTIMA TRAVEL (Ultima T&T Co., Ltd.)
to charge ................................. to my credit card.
 
Cardholder's Name :
as it appears on card		  
Card Number :  
Expiration Date :  
Cardholder Statement
Address :
  
 
 
Pay for Invoice No :  
Signature :
as it appears on card
 		 
 
Other Information / Comments
 
 
 
 
 
ULTIMA TRAVEL : Hotels, Resorts, Lodgings and Accommodations in .........
  Bangkok Pattaya Phuket Samui Phi Phi  Krabi  
Samet  Rayong Chang  Chiang Mai Chiang Rai Cha-am Hua Hin Ayutthaya
 

NOTE: We are real travel agent and tour operator with offices in Bangkok, Pattaya and Phuket, not just only Internet Reservation system.
Tourism Authority of Thailand - Licence No.11/02790