Credit Card Secure Payment Fax Form
Please print this form, ensure that it is fill it out completely,
and fax it to

Gem Travel: +66(0)53-818755 or 271681
*please omit the (0) if you are faxing from outside Thailand

I hereby authorise Gem Travel to charge 

US$ _____________ to my ___ Visa ___ MasterCard

*Payments are credited to our Thai account, translated into the
Thai Baht (THB) equivalent. Charges should appear on your credit
card  statement in your local currency based on the exchange rates
and according to your card-issuers policies. 

There are NO Thaifocus surcharges for using your credit card.

Name of persons staying: 
Choice of Hotel, (please try to give three choices): 
City of hotel:
Date check in (day you arrive): 
Date of Check out (Date you leave): 
Nights you will stay.
Number of Rooms: 
Type of room: Single, Twin, Triple:
Style of room: (e.g. superior, suite, bungalow):
Special requests.
    
Cardholders Name:(exactly as it appears on card) 
Card Number:(ie) xxxx - xxxx - xxxx - xxxx
Expire Date: (MM/YY) 
Cardholder's Home Address: 
Passport Number & Nationality: 
E-mail Address:  
Fax number: 
Telephone Number: 
Signature: (as it appears on card) 

Please print this form, fill it out completely, then fax it to Gem
Travel, +66(0)53-818755 or 271681

*We charge in dollars and submit our claim, in Thai Baht, to our
bank. There is a delay in crediting our account (by the local bank.
The overseas card issuer (via visa or mastercard) translates the
amount back into the currency chosen by the card holder. If the US$
is stronger on the day this occurs then the bill will be less than
the total US$ amount billed by Thaifocus/Gem Travel. It the Thai
currency rises in value (during the time between our submission and
the time when the bank submits this to visa) then the amount will
be slightly more than the the prices listed on our hotel rates.

Home Page http://www.thaifocus.com
Po Box 185, Mae Ping PO, Chiang Mai 50301
Tel:+66(0)53 272855, 818754  Fax: +66(0)53 818755
email: info@thaifocus.com Copyright 1996-99 
Thaifocus

Visiting Chiang Mai?
Call in at Gem Travel, 209/2 Sridornchai Road, Chiang Mai 50100,
Thailand