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CREDIT
CARD PAYMENT FORM - JB-HOTEL HAT YAI |
| I hereby authorized www.asianetonline.com to charge the amount of THAI BAHT . 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
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