RESERVATION REQUEST
 Last Name :
 First Name :
 Title :
 Company :
 Office Phone :
 Home Phone :
 Fax :
 E-Mail Address :
 City :
 State :
 Mobile :
   
 RESERVATION DETAILS
 Type of room required :
 Date of check-in :
 Date of check-out :
   
 FLIGHT INFORMATION
 Airline code/ Flight no. (arrival) :
 Time of arrival :
 Airline code/ Flight no. (Departure)
 Time of departure :
   
 CREDIT CARD INFORMATION
We can only reconfirm your reservation after we have received your full name, credit card number with expiry date, either by E-mail or facsimile.
 Credit card number :
 Credit card company :
 Expiry Date :
   
 ADDITIONAL REQUIREMENTS
 
   


158 Sritakuapa Road, Takuapa, Phang-nga 82110, Thailand
Tel : +66 (0) 7642 8111, Fax : +66 (0) 7642 8112 E-mail address :rsvn@khaolakresort.com

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