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Credit Card Authorization Form – Please Print Out

To reserve your room please complete the Credit Card Authorization Form below and fax it
back to our address below. Please note that a certain deposit is required to hold your booking.


Important: Please ensure that you receive confirmation by E-mail on
your booking request prior to sending this Credit Card Authorization.


To: Butterfly House FAX NUMBER: +66-76 345643


 
  
 
From ___________________________________
Address ___________________________________
Tel ______________ Fax  _________________
Email ___________________________________


Credit Card Details:
 
Date ___________________________________
 
I, ____________________________ (Name) authorise Butterfly House to
 
charge(amount)_____________ to my ( )Visa, ( )Master Card (please tick one)
 
Cardholder’s Name ___________________________________
Card Number ___________________________________
Expiry Date ___________________________________
Signature as on Card ___________________________________
  

Please include the complete number set of your credit card

© 2007 Butterfly House; all rights reserved.
111/1 Pisitkaranee, Patong Kathu, Phuket 83150, Thailand
Tel.: +(66) 76 343030 | Fax: +(66)76 345643
E-mail: info@butterflyhousephuket.com