Pre-Paid Hotel Credit Card Form

This is to authorise :

AT Network CO.LTD., THAILAND

To debit baht ................................................................................

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

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

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

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

For Payment of Reservation at Hotel: ......................................

Guest Name: .............................................................................

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 or 677-6247.
PLEASE ATTENTION TO MS. CANDY