Credit Card Form - Fax. (66-2) 399-1885 attn. Ms. Polly

Credit Card Form
This is to authorise : eINTERNETWORK CO., LTD., THAILAND

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 Bangkok Office at (66-2) 325-0926 attn. Ms. Polly

eHOTELBOOKING.COM
Thailand Hotels & Resorts Online Reservation Services
Bangkok Office : Tel. (66) 2751 5266 to 8 (66) 2325 0927 to 8 Fax. (66) 2325 0926
Open daily : (Mon-Fri) 9.00 am. - 6.00 pm. & (Sat) 9.00 am. - 1.00 pm.
Hotline : (66) 8 1850 3416, (66) 8 3989 6450, (66) 8 3989 6455