Please complete the form, print, sign
and
Fax to : 00-66-2 629-4714
| Full Name (as on card) | ||
| Email Address | Booking reference no. | |
| Address | ||
| Address 2 | ||
| City | State / County | |
| Post Code | Country | |
| Card Type | Bank Name : | |
| Expiry date |
MM/YY |
|
| Card Number |
Security Code
The last 3 digits of the number on your signature strip |
|
| Amount |
Thai Baht |
|
| Please read carefully |
We can only charge cards in Thai baht. Due
to exchange rate fluctuations and the fact that the actual exchange rate is dictated by your card company, there may be some difference between our quoted equivalent in other currencies and what appears on your card statement. We regret that this unavoidable. |
|
| Travel by |
No of passengers |
|
| Flight details | ||
| Departure date |
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DD/MM/YY | |
|
I, the undersigned, authorise my card to be
charged with the stated amount in Thai baht. I confirm that all information I have given is true and correct. | ||
| Signature(Please sign after printing) | _____________________________ | |