Credit Card Authorisation Form - by Fax
Please print this form, fill it out completely, and fax it back to us.

Fax No. + 66 2 435 7515

I wish to pay by :

AMEX VISA MASTER JCB

I hereby authorise Asian Splendour Holidays Ltd to charge   .................... Thai Baht to my credit card.

Cardholder's Name :
as it appears on card		  
Card Number :  
Expiration Date :  
Cardholder Statement
Address :
  
 
 
Pay for Invoice No :  
Signature :
as it appears on card :		  

 

Other Information / Comments
 
 
 

 

 

 

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