I hereby authorized  GOLDEN CLIFF HOUSE PATTAYA   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 :                                                                                     

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

Amex pleased inform Address Billing :___________________________________

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
(66 2) 541-9574 Att. Miss.Varin E-mail :rsvn@asianetonline.com

BAIYOKE SKY HOTEL