Credit Card Details
To Debit Baht :
 
Against Credit Card Type :
(VISA, MASTER, JCB, AMEX CARD only)
 
Batch Code :
(4 digit no. - AMEX only)
 
Credit Card Number :
 
The last three digit number
appearing on the signature panal :
 
Cardholder's Name :
 
Expiry Date :
 
Passport Number or
Indentity Card Number :
 
For the payment of :
 
Booking under the name of :
 
Period of Booking :
 
Cardholder's Signature :
 
Date :
Remarks : Kindly please print this form, fill-in your Credit Card details and fax it to our Office
(662) 816 8012