Hotel Thailand Car Rental Service

Reservation Form

Your Details:

First Name:*
Last Name:*
Nationality:*
Email:*
Address:
Phone:*
Fax:

Renter's Age:

Pickup Date:
Day
 Month
 		Year
 		AM/PM
 Time
 Flight Number


Dropoff Date:
Day
 		Month 
 		Year 
 		AM/PM
 		Time
 Flight Number


Intended Itinerary:
Pick-up location in Thailand:
Please specify more detail of location such as hotel name and phone number (if any):
Drop-off location in Thailand:
Please specify more detail of location such as hotel name and phone number (if any):
Driving License No. :    Expiry Date :

Type of vehicle desired:


Special Requirements:
Baby Seat
Street Directory

Other Requests

(Ask about our free delivery and pickup.)

Number of people travelling:
Adults:

Credit Card Details to Guarantee 1 day of reservation to debit:
Card Type:
Master Card   VISA Card   American Express Card Click here to view
Exchange Rates
Card Number:
Security Code:
Please advise the last 3 digit number or 4 digit number (for AMEX) appearing on signature panel (if any) (See example)
Expiry Date:  
Holder Name:
Issuing Bank / agency & Country

If you encounter any difficulties sending your booking details through this form, you may print a copy of our credit card charge form. Once complete, please fax the form back to us at (662) 502-0757,(662) 962-2536 or call us at (662) 100-8010

 

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