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 :
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2001
2002
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
eINTERNETWORK Co.,Ltd :179 Bangna-Trad Km1 Rd., Bangna, Bangkok, Thailand 10260
Tel. (66) 2751 5266 to 8 (66) 2325 0927 to 8 Fax : (66) 2325 0926
Email :
Info@ehotelbooking.com
ICQ. 93002020
Copyright (c) 2000-2001 eINTERNETWORK All Rights Reserved.