This is to authorise :

AT NETWORK CO.,LTD., THAILAND

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

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

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

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

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

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

for the following tours :

1) ....................................................

2) ....................................................

3) ....................................................

4) ....................................................

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 to 7 (2 lines).
PLEASE ATTENTION TO JULIA.