Asian Premier Holidays Co., Ltd.

74/90 Poonphon Rd, Tambol Talad Nua
Amphur Muang, Phuket 83000 Thailand
Tel: (66 76) 246260, Fax: (66 76) 246270/1
E-mail :,

Please fill this form up completely, and fax it to Asian Premier Holidays
Fax No: (66 76) 246-270 or (66 76) 246-271

I hereby authorize Asian Premier Holidays to charge Thai Baht / USD / SGD* ______________ to my (Visa / Master Card)* card. *Please circle.

Remarks: Faxes sent to the above numbers will ensure that your reservation will be processed immediately.

Cardholders Name (as on card):  
Guest's Name:  
Card Number:
* for VISA and Master Card users, please fill in 3-digits CVV / CVC number printed at the back of your card.
Expiration Date:  
Passport Number:
Postal Address:
Address as
given to your credit card company. :
Phone No.:  
Fax No.:
E-mail Address:  
Hotel 1: Arrival: Departure:
Hotel 2: Arrival: Departure:
Hotel 3: Arrival: Departure:
Other Information:
(as on card):