I hereby authorized  www.asianetonline.com  to charge the amount of

BAHT                                                                                  

from                                               to                                              

Cardholder's Name :                                                           (as it appears on card)

Guest's Name :                                                                 (if different from above)

Card Number :                                                                      

Master/VISA Card - 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 :rsvn@asianetonline.com