| CREDIT
CARD FAX FORM - RAYONG RESORT |
| I hereby authorized RAYONG RESORT, RAYONG 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 show on the back of the card : AMEX :4 digits 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 |