I hereby authorized  IMPERIAL TARA 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 :                                                                                     

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