Hmong Hilltribe Lodge, Chiangmai Thailand - Reservations Form

PERSONAL INFORMATION :

Important !!! Please furnish full name.
Title - First Name - Last Name	Mr. Miss Mrs *
Important !!! Please furnish complete e-mail address so that our reply could reach you.
E-mail Address :	* ( Correspondence E-mail address)
E-mail Address :	( Second E-mail address, if any )
Fax No :
Telephone No :
Correspondence Address :
Country :
Nationality :	*

RESERVATION / BOOKING INFORMATION :

Types of package required :	• Please Select Packages • Hilltribe Adventure 2 Days/1 Night Hmong Soft Adventure 3 Days/2 Nights *
Types of room required :	• Please Select Rooms • Standard Room Superior Room Deluxe Room *
Types of bed :	Single Twin sharing
Number of rooms required :	1 2 3 4 5 6 7 8 9 *
Extra bed :	Yes No
Number of person (adult)s :	*
Number of children (if any) :
Age of children :
Indicate here if more than 1 type of rooms are required. Please also furnish names of the guests for the additional rooms
Indicate here for any special request (bed types preferred, connecting room, etc.)
Date of check in :	( i.e. January 1, 2005 )
Date of check out :	( i.e. January 1, 2005 )
Preferred payment method :	by Visa Card by Master Card by JCB Card by Amex Card Other ...

FLIGHT INFORMATION :

Arrival Flight :	Flight Name and No. ( i.e. TG 999 )	Time of Arrival ( i.e. 5:30 p.m. )
Departure Flight :	Flight Name and No. ( i.e. TG 999 )	Time of Departure ( i.e. 5:30 p.m. )
Please indicate if airport pick up service is required : Yes No

Remark : * Required Information

If you encounter any returned e-mail OR difficulties sending your booking details through this form, you may send your booking details to our help desk at our main reservation office at e-mail address contact@e-biz-travel.com At your services always !