CREDIT CARD FAX FORM - FERN RESORT Mae Hong Sorn

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.

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