Credit Card Fax / Mail Order Form

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