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	+84 43 722 5869

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Hotel Booking Request Form

Thank you very much for the trust you place in Indochina Travel Service. For booking hotel, please fill in our form below. We will respond to you within 24 business hours.

Don't like filling form? please email us directly.

Please Note: Fields with asterisks (*) are required.

Hotel Information

Hotel Name:

Ta Prohm Hotel

City / Town:

(*)

Check-in date:

(*)

Minimum advance booking of 72 hours required.

Check-out date:

(*)

Number of rooms:

Single: Double: Twin: Extra bed: (*)

Room grade:

(*)

Number of nights:

(*)

Flight Ref & Arrival time:

Alternative hotel:

(In case the above hotel is not available)

Do you need airport transfer?

One-way

Round-way

None

Guest Information

Contact person:

(*)

Email:

(*)

No. of guests:

Adult: Children: (for child under 12 only) (*)

Companions' name:
(Please write full names separated by a comma)

Nationality:

Address where we can contact you:

Tel / Fax:

Additional Information

Remarks
(special request for room, tour, flight booking):

What is your travel type?

How did you hear about us?

Important information about your payment

In order to secure your booking, a NON –refundable 10% (ten per cent) deposit of the booking cost with the minimum of USD100 per person is required. This amount will be charged directly to your credit card ONLY when your requested hotel and room(s) are confirmed; you will be notified by email. The balance must be paid at least 4 weeks (28 days) before check- in date.
Full payment will be required at this point of time if your booking cost is less than USD200 or if your booking date with us is less than 28days.
Cancellation and no show terms apply.

I have read and agreed with your Terms & Condition.(*)

Check out and payment
(This step is just to verify our clients. Your Card will not be charged unless your booking is confirmed.):

Debited Amount (USD):	(*)
Credit card type:	(*)
Name on card:	(*)
Billing address:	(*)
Country:	(*)
Credit card number:	(*)
Card ID:	(*)
Credit card Bank:	(*)
Expiry date:	(*)
Confirm your e-mail:	(*)