Credit Card Authorization Form       [HOME] 

 

Royal Exclusive Travel Co., Ltd.                                  
No. 9 The Place 4th Floor, Room 92-9404, Chan Rd. 18/2
Thungwatdon, Sathorn, Bangkok 10120, Thailand  
Tel: +66 (0)2 676 4182-7,  (0)2 286 4950-1

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For safety reasons, we recommend that the payment be done by FAX.  The intructions are given below:

  • Please Print out this Credit Card Authorization Form
  • Fill in and sign this printed form
  • Photocopy your Credit Card - Front & Back Side
  • Fax the copy of your credit card (Front & Back Side) together with this signed Authorization Form to our Fax no. +66 (0)2 676 4188, (0)2 286 4959

Credit Card Authorization Form

Cardholder's Name:_______________________________________________________

Home Address       :_______________________________________________________

                               _______________________________________________________

                               Country:_______________________Zip Code:________________

I hereby authorize Royal Exclusive Travel Co., Ltd. to charge:

Amount (USD / Thai Baht):  (_____________)

Amount in Word:________________________________________(USD/Thai Baht only)

on my Credit Card -  (   )  Visa Card      (   )  Master Card     (    ) American Express

Card Number: (__________________________________), Expire on: (____________)

For Services:____________________________________________________________

               ____________________________________________________________

                                                                

                                                       Signature of Cardholder:_____________________

                                                                                       Date:_____________________

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For Official Use Only

Approval Code:_____________________Amount in Thai Baht________________

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