PAYMENT BY AMERICAN EXPRESS CARD

CREDIT CARD AUTHORIZATION FORM
Your Credit Card is Safe with Trails Of Asia

For safety reason, we strongly recommend to print out and complete this form in full detail and
return it to us by fax with the copy of both sides of the credit card to +66-2-8827294.

Cardholder's name: (Mr./Mrs./Ms.)___________________________________________________

Home Address: ____________________________________________________________________

_________________________________________________________________________________

Phone: ____________________________________ Fax: __________________________________

E-Mail: ___________________________________________________________________________

I hereby authorize Trails Of Asia Co., Ltd. to charge on my credit card:

Amount in Thai Baht: _______________________________________________________________

Amount in word: ___________________________________________________________________

Card number: ___________________________________ Expiry date: _______________________

For services: ______________________________________________________________________

Signature of cardholder: ________________________________ Date: _______________________


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