Fax Form   Please print this form, complete and fax to reservations on +66 76 333 473 Hotel Name .....................................................................   your email .....................................................................   your fax number .....................................................................   your telephone number .....................................................................   name ..................................................................... as shown on credit card statement address (line 1) ..................................................................... as shown on credit card statement address (line 2) .....................................................................   city .....................................................................   country .....................................................................   credit card number .....................................................................   credit card type AMEX Master Card Visa   credit card cvv (for VISA and MasterCard only) ..................................................................... CVV is the last 3-digit number on the signature area of the card credit card expiry date .....................................................................   amount to pay .....................................................................   currency US$ Thai Baht   I authorise PhuketHotDeals.com to process the payment for my booking. card holder's signature ...................................................................as it appears on credit card date .......... /.......... /.......... comment ................................................................................................................................................................... ................................................................................................................................................................... we will confirm receipt of this fax within 24 hours. if you do not receive this confirmation please contact us. address: 46 Karon Road, T. Karon, A. Muang,PHuket 83100 telephone: +66 81 271 6875   facsimile: +66 76 333 473   email: info@phukethotdeals.com