| CREDIT
CARD FORM - BANITO BEACH RESORT |
|
I hereby authorized www.asianetonline.com to charge the amount of THAI BAHT .
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 : 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 |