Credit Card Payment Form - Bann Pae Cabana Resort 
To guarantee your booking, please printout this form, complete all the information and fax to
Fax (662) 541-9574
Full payment will be charged trhough your credit card the reservation is confirmed.
Currenlty we accept only Visa, Masterm , Amex or JCB cards.

I here by authorized      www.asianetonline.com                to charge the amount of

Thai Baht                                                            

to my credit card for my accommodations from __________________ to:                                     

Name :                                                                      Country:                                                 

Credit card company :                                                                                                             

Credit card no.                                                            Expiry date :                                         

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

AMEX Card : pleses billing address :___________________________________________

SIGNATURE : _______________________________ Date :