Authorization of Charge
Please fill in the information, check the applicable boxes, sign it and fax it back to us at (66 2) 237-9322
Card Type: .........................................................................
Card Holders Name: ..................................................................
Card Number: .....................................................................
Cvv Number: ................
Expiration Date: ............ / ............
Amount Authorized in Thai baht: ................................ Baht (include VAT 7%)

In Payment Of: One night reservation deposit  
    for No of adults..........................
for No of children.......................
 
Room Information
  Room Type
Now - Oct. 31, 2015
Nov. 01, 2015 - Feb 29, 2016
Single Room w/shower (small bed for 1 pax)
1,000 Baht x 7% vat
1,000 Baht x 7% vat
Twin/Double Room w/shower(big bed for 1or2 pax)
1,500 Baht x 7% vat
1,800 Baht x 7% vat
Suite with sitting room
2,000 Baht x 7% vat
2,300 Baht x 7% vat
Studio Suite w/garden balcony
3,000 Baht x 7% vat
3,000 Baht x 7% vat
       

 

* These rates are inclusive of 10 % Service charge and American Breakfast already.

 

 

Extra Bed (Including breakfast)
600 Baht
Check In date.................................... Check Out date.......................................  
Total number of nights...................................  
 
Total Room Price
.....................Baht 


Pickup Service Information(optional)
 
Single Trip :Car pick up at airport [1-2 pax]
1,200 Baht 
Single Trip :Car pick up at airport [3-7 pax]
1,600 Baht 
Single Trip :Limousine [Toyota Lexus][1-3 pax]
2,500 Baht 
Flight#.................. Arrival date..............Time..............


 
Total Pickup Service Price
.....................Baht 
     
 
Total Price
.....................Baht


I here with authorize, La Residence Hotel , Bangkok Thailand to charge the above stated amount on my credit card.

Authorized Signature......................................................................................

First Name...............................................Last Name.......................................

Date...............Month.............Year.............