Credit Card Form Fax : (+66 2) 250 6324

This is to authorise : Siammedee Business Travel Co., Ltd. Thailand / TAT TRAVEL LICENSE No. 11/4190
: 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) 250-6324 attn. Ms.GiGi

Siammedee Business Travel Co.,Ltd : 555/8137 Pratunam Center, Room No 2137 Rajprarop Rd., Rajthevee, Bangkok, 10400 Thailand.
Tel : (+66 2) 250 6324, (+66 2) 309 8137 Fax : (+66 2) 250 6324
Email : info@siammedee.com