| This
is to authorise for online payment submit.
Window
Tour Service Co.,Ltd
41/181 Soi-Inthamara 29,Suthisarn Road,
Samsennai,Phayathai,Bangkok 10400,Thailand.
Tourism Authority of Thailand license ( TAT no.,12-00381)
Please
Print out and Fill up this form
and Fax to Bangkok Office 662-6160967
Service
Date :
______________________________________________________
Booking's
Name : ___________________________________________________
Cardholder's Name:_________________________________________________
(same
Booking name
& Your Credit
Card)
Passport Number:__________________________
Country : _______________________
Visa Card Number:
______________________________Security Code:___________
(
Security
Code
is 3 or 6 digit number that is print on the back of Credit
Card )
Master
Card : ___________________________________Security
Code :_________
(
Security
Code
is 3 or 6 digit number that is print on the back of Credit
Card )
American
Express Number: _________________________
Security Code :_________
( Security is 4 digit number is print on
the Front of Credit Card )
Credit Card Expire : ______________
Country of Credit Card issue : _________________
Name
of Credit Card issue ( Bank,Finance ,etc)
: __________________________________
I
hereby authorize a charge of Amount and Currency below.
US-Dollar:___________________________
Thai-Baht: ______________________________
Amount in Letter : ____________________________________________________________
Payment
Of : _________ ________________________________________________
( Hotel ,Package Tour , Air-Ticket, Transportation,
etc., )
Cardholder's
Billing Address & Street: __________________________________________
_____________________________________________________________________________
Country: __________________________________________Zip
Code : _________________
Area Code: ___________
Tel: _______________________ Fax:______________________
E-Mail
Address : ____________________________________________(
Important )
Signature: _________________________________________________
Date : ___________
( same Signature
on Your Credit Card )
Please contact us if you do not receive confirmation-mail within 6 hrs or
call 6681-3351155
please
email to E-mail info@thailandvoyage.com
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