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RESERVATION FORM

Veuillez compléter la forme ci-dessous pour s’informer au sujet des chambres disponibles. Notre personnel vous répondra dans un délai de 24 heures. (Notez svp que toutes les réservations seront sujettes aux chambres disponibles.)

Please fill in the required fields marked with *.

First Name:*
Last Name:*
Email:*
   
Phone:*
Fax:
Number of Guests:*
   

Room Type:*
No.# of rooms:*
Check-in Date:* Check-out Date:* Total in USD
Sub Total:
4% Service Charge:
Grand Total:

Coming From:
   
Arrival Time:
   

     Please provide additional information/comments/questions here:

 

In order to secure my travel services, I authorize The Elephant Crossing Hotel to charge my Credit Card,
the number of which and amount are stated below:

 
Name of your bank as issue the card:
Cardholder's name:
Date of Birth: (DD/MM/YYYY)
Passport No.: Country:
Type of Card:
Card Number:
Expiration Date: (MM/YY or MM/YYYY)
Amount in USD:
CVV2/CVC2: (Last 3 Italic digit back card)

**Please note that room rates are subject to change without notice. You will be notified of changes in your booking confirmation by email prior to any reservations are made in your name. The transaction for payment via visa will be made on confirmation of the booking and is NOT REFUNDABLE.**


www.theelephantcrossinghotel.com, Email: info@theelephantcrossinghotel.com

©Copyright 2013 The Elephant Crossing Hotel, PO Box 5512, Vientiane, Lao PDR.
Telephone/Fax: +856-(0)23 511232 ,634, Mobil: +856-(0)20 55602830 or +856-(0)20 22454730