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

AMEX - 4 digits code :                         Expiry date :                                

Card company :                                        Country:                                    

SIGNATURE : _______________________________ Date : _____________________

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office
at (662) 541-9574 Attn. MISS VARIN E-mail : rsvn@asianetonline.com