I hereby authorized  BANGKOK PALACE HOTEL,  to charge the amount of

THAI BAHT                                                                    

for period from __                            ___ until                                       

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

Guest's Name :                                                            (if different from above)

Card Number :                                                                            

Master / VISA - the last 3 digits show on the back of the card :_________

AMEX - 4 digits code :                                     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 Attn. Miss Varin E-mail :rsvn@asianetonline.com