MUANG PAI RESORT- Credit Card Payment Form
Please printout this form, complete all the information and fax to (662) 5419574
== Full payment will be charged through your credit card the reservation is confirmed.
== Currently we accept only, VISA, MASTER AMEX OR JCB CARDS.


I here by authorized      www.asianetonline.com       to charge the amount of

Thai Baht                                                                           .

to my credit card for my accommodations from __________________ to:                                       

Name :                                                                               Country:                                          

Credit card company :                                                                                                               

Credit card no.                                                                   Expiry date :                                    

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

AMEX CARD : Please inform billing address____________________________________________

SIGNATURE :______________________________________Date :___________________________