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 :                                                                                     

VISA/Master - the last 3 digits show on the back of the card :                   

AMEX - 4 digits code :                    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 :info@asianetonline.com