CREDIT CARD FORM

E-business Allance Co., Ltd

Please debit ............................................................................... Baht

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

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

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

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

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

Booking name : ...........................................................

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

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

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

Please print this form, fill-in your details and fax it back to our Bangkok Office at (662) 100-8010 Attn. Reservation Department. or call us at (662) 100-8010