CREDIT CARD FORM

E-business Allance Co., Ltd

Please debit (Amount) ................................................................... Baht

Against Credit Card : ..............................................................
[ VISA, MASTER, AMEX or JCB]

Credit Card No. .............................................................................

Cardholder Name : .........................................................................

Expiry date : ................................................................................

For payment of : ..........................................................................

Passenger name : ............................................................................

Signature of Cardholder : ...............................................................

Date : ........................................................................................

*********************** IMPORTANT **********************

Please kindly print this form, fill-in your details and fax it back to our Bangkok Office at (662) 643-1193, (662) 246-2259 Att. Jane or Dan E-mail : jane@hotelthailand.com