Credit Card Form - Fax. (66-2) 325-0926 attn. Ms. Polly

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

To Debit Baht :
Batch Code : (4 digit no.)
Credit Card Number :
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

www.eHOTELBOOKING.COM
Thailand Hotels & Resorts Online Reservation Services
Bangkok Office : Tel. (66) 2751 5267 to 8 (66) 2325 0927 to 8 (66) 2751 5224 Fax. (66) 2325 0926
Hotline : (66) 8 1850 3416, (66) 8 3989 6455