I hereby authorized  UTOPIA SUITES , KOH TAO  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 Att. Miss Varin E-mail :rsvn@asianetonline.com