Credit Card Form
Please fill in the below form and copy your card both front and back side, then fax them to us.

This is to authorise :

AT NETWORK CO., LTD., THAILAND

To debit Baht................................................................................

For payment of.............................................................................

Booking under the name of..........................................................

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

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

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

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

BATCH CODE (FOR AMEX ONLY) : .......................................
(the four digits on the right hand side above the card number)

Last 3 digit number appearing on signature panel (only Master Card) .............................

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 (2 lines)
PLEASE ATTENTION TO ...............