Credit Card Form
This is to authorise : Siammedee Business Travel Co., Ltd., Thailand
:
Hotel Name
:
Period of Booking
:
Booking under the name
:
Credit Card Type
(VISA, MASTER, JCB, AMEX CARD only)
:
Credit Card Number
:
Credit Card Issuer
:
Country
:
Cardholder's Name
:
Expiry Date
:
The last three digit number
(
Appearing on the credit card signature panal)
:
Batch Code
(
4 digit no. - AMEX only)
:
Passport Number or Indentity Card Number
, And Issuer
:
To Debit Baht
:
Cardholder's Signature
:
Date
Kindly print this form, fill-in your Credit Card details and fax it to our Bangkok Office at (66-2) 880-4881 attn. Ms.GiGi
Siammedee Business Travel Co.,Ltd : 53-53/1 Rajdamri Road, Tambon Prapathomchedi, Amphor Mueang, Nakhonpathom 73000 Thailand.
Tel : (66 2) 880 4881, 497 1588, 034 217 042 Fax : (66 2) 880 4881
Email :
info@siammedee.com