Travel-here.com
Credit Card Information Fax Form

Please Print this form, fill it out completely, and fax it to the following Travel-here fax number:

Malaysia +60-3-227 210 23

+indicates dialing your code for international calls

I hereby authorize a charge of__________________
to my Visa   Master

(We will soon accept American Express, JCB and Diners Club, sorry for any inconvenience caused)

Please contact us if you do not receive confirmation of our receipt
of this fax form within 48 hours of sending it.

Cardholder's Name:
(as it appears on card)		  
Guest's Name:
(if different from above)		  
Card Number:
 (Including the last 3 digit number appearing
   on the signature panel) What is a veryfication code?  		 
Expiration Date:  
Card Issuing Country  
Card Issuing Bank  
Cardholder's Address:
 Street/ZiP Postal Code/City/State/Country


 		  
E-Mail Address:  
Phone number:  
Hotel(s) / Dates:  
Booking ID:  
Signature:
(I, the cardholder hereby authorize this charge to my credit card for the hotel booking detailed above made under the name of the guest indicated above.)