Credit Card Form - Transfer Service

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 : ...............................................................................

For Payment of Transfer Service from: ......................................

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 CANDY.