| CREDIT
CARD FAX FORM |
| I hereby authorized to charge the amount of .
Period 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 : ____________________ *********************** IMPORTANT ********************** Please
kindly print this form, fill-in your details and fax it back to our Bangkok Office
at |