|
CREDIT
CARD FAX FORM - BARALI BEACH RESORT
|
|
I hereby authorized www.asianetonline.com to charge the amount of BAHT from
__ ___
to: Cardholder's Name : (as it appears on card) Guest's Name : (if different from above) Card Number : Master Card - 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 |