I hereby authorized AMARI ORCHID RESORT, PATTAYA   to charge the

amount of USD $                                                                    

from __                            ___ to:                                       

Cardholder's Name :                                                        (as it appears on card)

Guest's Name :                                                            (if different from above)

Card Number :                                                                            

Master Card : write down the last 3 digits show on the back of the card :               

AMEX : please inform Billing address                                                                        

Expiry date :                             Card company :                                

Country:                                               

SIGNATURE : ___________________________ Date : _____________

*********************** IMPORTANT **********************

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office at
(66 2) 541-9574 Att. Miss Varin E-mail :rsvn@asianetonline.com