Credit Card Form

This is to authorise :

AT NETWORK 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 No : ..........................................................................

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

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

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

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

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

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 .......................