(KINDLY PRINT THIS FORM AND HAVE THE SAME FAXED ON FAX NO.00-91-22-6932526
 ALONGWITH A COPY OF THE FRONT AND REAR OF THE CREDIT CARD)


To,
The Reservations,
Citizen Hotel,
960,Juhu Tara Road,
Mumbai 400049,
India.	

Dear Sir,

With reference to my booking, my credit card details are as follows:  

CARD HOLDERS NAME 	:	
(As appearing on card)

CARD TYPE		:
(Amex,Visa,Diners,etc.)

CARD NUMBER 		:

DATE OF ISSUE 		:

DATE OF EXPIRY 		:

AMOUNT AUTHORISED TO BE DEBITED :
(ONE NIGHTS ROOM CHARGE)

Enclosed herewith please find a photocopy of the front and rear of the 
credit card. 

Thanking you

NAME		:

SIGNATURE 	:

DATE 		: