HOTEL SIXTY3 MANUAL ORDER / TELEPHONE ORDER FORM (MOTO)
This form shall assist us in placing your booking via manual credit card charge. All bookings placed through this method will be processed by our team within 1-3 days of receiving this form. The amount of stay shall be charged to your card before your stay date to confirm your booking
Full Name of Guest
*
First Name
Middle Name
Last Name
E-mail
*
MOBILE Number
*
-
Area Code
Phone Number
Passport / MYKAD Number
*
DETAILS OF BOOKING
ROOM 1
CHECK IN DATE
*
-
Month
-
Day
Year
Date Picker Icon
CHECK OUT DATE
*
-
Month
-
Day
Year
Date Picker Icon
TOTAL NUMBER OF NIGHTS
ROOM TYPE
*
Please Select
SUPER STANDARD KING
SUPER STANDARD TWIN
SUPERIOR KING
SUPERIOR TWIN
FAMILY DELUXE(TWIN QUEEN)
EXECUTIVE DELUXE
SUITE KING
TOTAL NUMBER OF PAX
*
Please Select
1
2
3
4
5
RATE TYPES
*
PROMO RATE NON-REFUNDABLE DEAL
CANCELLABLE - T & C APPLIES
OUR INTERNET RATE
TOTAL FOR YOUR STAY MYR (ROOM1)
Would you like to book another room ?
Yes
Only 1 room,thanks
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CHECK IN DATE
-
Month
-
Day
Year
Date Picker Icon
CHECK OUT DATE
-
Month
-
Day
Year
Date Picker Icon
TOTAL NUMBER OF NIGHTS
ROOM TYPE
Please Select
SUPER STANDARD KING
SUPER STANDARD TWIN
SUPERIOR KING
SUPERIOR TWIN
FAMILY DELUXE(TWIN QUEEN)
EXECUTIVE DELUXE
SUITE KING
TOTAL NUMBER OF PAX
Please Select
1
2
3
4
5
OUR INTERNET RATE
Check the rate from our website. Leave blank if you are not sure
RATE TYPES
*
PROMO RATE NON-REFUNDABLE DEAL
CANCELLABLE - T & C APPLIES
TOTAL FOR YOUR STAY MYR (ROOM 2)
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YOUR CREDIT CARD DETAILS
By completing this form, I hereby authorize HOTEL SIXTY3 (wholly owned by BINYAN PROPERTIES SDN. BHD.) to debit my credit | charge card as stated above. I attach herewith a copy of my identity card | passport together with the front face of my credit | charge card. Please be advised that in order to enjoy promotional rates from our internet booking, full rates of your whole stay will be charged directly to your credit card prior to arrival.
Attach a photo of your Identity Card
On a mobile device, you can take a photo of your Passport, MYKad or IC. Max file size is 1.2MB only
Attach a photo of your Credit Card
On a mobile device, you can take a photo of your (Front face) of the card which shows the Number and Name clearly. Max file size is 1.2MB only
TOTAL TO BE CHARGED (ROOM 1 + 2)
Automatically calculated
Signature
*
Sign Your Form
Please complete the below digital signature by using your mouse / pad to sign.By signing this, it verifies that all the above information is correct and that you authorise Hotel Sixty3 to charge the appropriate amount to your card
I agree to have the amount for my booking charged to my Credit Card by Hotel Sixty3 and accept all Terms & Conditions of Booking
*
YES
Submit
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HOTEL SIXTY3 OFFICE USE ONLY
MOTO PROCESSED BY
DATE OF PROCESS BY
CONFIRMED BOOKING NUMBER
REMARKS
Calculation
Should be Empty: