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CREDIT
CARD PAYMENT FORM -
Rabiang Dao
Garden & Resort
Please
printout this form,
fill it out completely all the information and fax to our
reservations fax line Thailand : at (66 2) 541-9574 Full payment will be charged through your credit card after the reservation is confirmed. Currently we accept Only Visa, Master Amex or JCB cards. |
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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 :________________ AMEX : please inform Billing address : ________________________________ ________________ 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
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