Fargo Co., Ltd. - Credit Card Information Fax Form

Credit Card Information Fax Form : Authorized by Fargo Company Limited

Please Print this form, fill out completely and fax it to the following fax number: Thailand : + (662) 2191713

Fax-in Payment

Transaction Date :

Personal Particulars

Name	: ................................................................................................................
Telephone	: ................................................................................................................
Email	: ................................................................................................................

Payment Particulars

Credit Card Type	VISA MASTER
Credit Card Number	: ................................................................................................................
Secure Number (The last 3 to 4 digit number appearing on the signature panel)	: ................................................................................................................
Card Holder's Name	: ................................................................................................................
Expiry Date(MM/YYYY)	: ................................................................................................................
Remark(s)	: ................................................................................................................
	................................................................................................................
Card Holder's Signature	: ................................................................................................................

Booking Particulars

Hotel / Package Name : ...........................................................................................................................

Room Type

Check-In Date
(day/month/year)

Check-Out Date
(day/month/year)

Guest Name :

I understand that Fargo Co., Ltd. will appear on my credit card statement for this transaction and that should I have any problems with this order, I can contact Fargo Co., Ltd. for a prompt resolution by emailing reservation@fargotravel.com or calling (662) 219 1722 (Auto).