I hereby authorized  CITY BEACH, HUA-HIN / CHA-AM   to charge the

amount of THAI BATH                                                                           .

from __                                ___ to:                                             

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

Guest's Name :                                                        (if different from above)

Card Number :                                                                             

Expiry date :                              Card company :                               

Please write down the last 3 digits show on the back of the card :______

Amex card please inform Billing Address_____________________________

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 Att. Miss Varin E-mail :rsvn@asianetonline.com