Payment Form

Please complete the form below and fax to us your credit card information to guarantee your hotel reservation. Our fax number is : (++84)4 39233-663

I, am__________________________________________ , authorize Art Hotel Hanoi to debit my credit card account total.

Amount US$__________________VND________________________ to be the payment for my hotel room charges.

My hotel reservation is as follows:  (Ref:_______________________________)

Hotel Name: _____________________________________________

City:___________________  Number of hotel room: _______________

Hotel guest name:__________________________________________

Check-in date:__________________   Check-out date:___________________________ (dd/mm/yy)

Total Order Amount: US$______________________________

Note: We accept. Visa ,Master only

I agree Art Hotel Hanoi to charge my credit card for one room night charges for each room reserved if I do not check-in the hotel on the first night as reserved.

Credit Card Number:___________________________________________

Expiry Date: ____________________________________________(mm/yy)

Card Holder's Name:_______________________________________
(same as appear on your credit card and same as the person check-in the hotel)

Billing Address: __________________________________________________________

_______________________________________________________________________

My Email Address:_________________________________________________________

Tel:____________________________________________ Fax:_____________________

Card Holder's Signature: _________________________Date:______________________