Credit Card Payment Form by Siammedee.com (Siammede.com)
Credit Card Payment Form - This is to authorise : Siammedee Business Travel Co., Ltd.
: 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) 880 4881, (66 34) 243 537
If you have any suggestions or comments, Please contact us at send an enquiry.
Siammedee Business Travel Co.,Ltd. TAT TRAVEL LICENSE No. 14/00615
Bangkok Office : 8.00 am. - 5.00 pm. (Mon-Fri)
53-53/1 Rajdamri Road, Tambon Prapathomchedi, Amphor Mueang Nakhonpathom, Nakhonpathom 73000 Thailand.
Tel : (66 34) 217 042, (66 2) 482 1254 Fax : (66 2) 880 488 © Copyright Siammedee.com All rights reserved.