Cardholder's
name___________________________________________________________ Billing Address :
_____________________________________________________________
__________________________________________________________________________
Country :
________________________ Zip Code : ________________________________
Email
Address ________________________________
I hereby authorize Sby
leisure Travel and Tours to
charge:
Amount in Thai Baht _____________________
( ) Visa Card
( ) Master Card
***The
Last three digit number appearing on the signature panel
Cardholder's name ( as
appears on credit card )__________________________________
_______________________________________________________________________
Expiry date (mm/yy) _______________________________________________________
Comments
:______________________________________________________________
_______________________________________________________________________
Signature of
Cardholder: ___________________
Date : ___________________
|
