: Seacanoe Thailand 367/4 Yaowarat Rd., Phuket Town, Phuket 83000
Tel./Fax. 66 76 212252, 66 76 212252
CREDIT CARD AUTHORIZATION / BOOKING FORM
( ALL contact numbers must be current for banking purposes)
Full name :*
Address :*
City : State/Province:
Postal code :
Country :
Telephone : *
Fax :
E - mail :*
I authorize Sea Canoe Thailand Co.,Ltd. to use my credit for payment in to
Siam Commercial Bank, Chao Fa Road, Phuket Town, Phuket. Thailand
Tel & Fax to: 66 76 212172 / 66 76 212252. A/C No. 663-3-01300-3
Sea Canoe trips:*
- All prices are quoted in Baht per person.
Trip On:*
No. of people:*
Total Amount:*
Amount in words:*
Name (as on card):*
Credit Card Type:*
Credit Card No.:*
Expiration Date:* CVV (last 4-digit on the back):*
:Digit Number (If by Master & Amex)
The last three (for Master) and four (for Amex) of digit number appearing on the signature panel
Signature as on card:*.............................................................
Date of signing:*......................................................................
Nationality:.............................................................................
Passport Number:*
Notice:Deadline for payment is before 18:00 hrs. If payment is not
received by deadline, your reservation may be given to another guest.
Cancellation: If you cancel a trip, the following penalties apply from
the day we receive written notice of cancellation.

 


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