Your Name:
Your Email Address:
Your Physical Address:
State:
Postcode:
Country:
Place of stay:	Hotel Manhattan
Arrival Date:	01020304050607080910111213141516171819202122232425262728293031JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember20082009201020112012
Departure Date:	01020304050607080910111213141516171819202122232425262728293031JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember20082009201020112012
Number in party:	Adults Children Infants Total 0001020304050607080910111213141516171819202122232425262728293031323334353637383940 0001020304050607080910111213141516171819202122232425262728293031323334353637383940 000102030405060708091011121314151617181920
Number of rooms required:	0102030405060708091011121314151617181920
Request Connecting Rooms:	NoYes
Payment Methiod:	Money Order
	SWIFT Transfer
	Mastercard
	VISA
	JCB
	Diners Club
	American Express
Name of Cardholder:
Expiration Date:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2008 2009 2010 2011 2012 2013
Card number	--- American Express --
This is currently not a secure link. If you wish to pay by credit card, you may (instead of sending us your card information by ordinary e-mail) print out this form, fill in the necessary data and fax the sheet back to Manhattan Hotel on (+66-2) 2553481.
Notes: (No Carriage returns please!)