I hereby authorized PLAZA ATHENEE E HOTEL,BANGKOK   to charge the

amount of USD $                                                                                    .

from __                                ___ to:                                             

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

Guest's Name :                                                                     (if different from above)

Card Number :                                                                                     

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

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