CREDIT CARD FORM - BANGKOK & PATTAYA PACKAGE

This is to authorise :

AT NETWORK CO., LTD., THAILAND

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

Against Credit Card Type : ........................................................(Visa, Master, JCB, AMEX only)

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

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

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) 677-6246-7
PLEASE ATTENTION TO ALICE.