Credit Card Form - June Bahtra Cruise

This is to authorise :

AT NETWORK CO., LTD., THAILAND

To debit Baht..........................................for June Bahtra Cruise

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

Period of booking : ..................................................................

Against Credit Card Type : ........................................................
(ONLY VISA, MASTER, JCB, AMEX CARD)

Batch Code (4 digit no. - AMEX only) : ......................................

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

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

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

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

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

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

Please kindly print this form, fill-in your Credit Card details and
fax it to our Bangkok Office at (66-2) 677-6246 to 7.
PLEASE ATTENTION TO PAM.