Phang Nga Discovery Tour Ltd., Part
Tel / Fax 66-76-314037 HP.66 1 3702114
E-mail: info@phuket-discovery.com
Credit Card Payment Form
Phang Nga
Discovery Tours requires credit card payment for _________________________________________
(Refer
To pay with credit card to Phang Nga Discovery Tours, please complete the following form and
fax it back to us at
No. 66 76 314037 if you fax machine has the
capability, please fax this on “Fine” or H. Tone for rarity.
I nearby authorize Phang Nga Discovery Tours Ltd., Part (Phuket)
to deduct a total amount for
________________ Thai bath from my: Visa / Master card (Please circle).
Please add 3 % to your total for processing bank charge.
Total amount in (Thai bath) including 3 % bath. = ____________ + 3 % = ___________ Thai baht
Full name
__________________________________________________________
Credit card No.
______________________________________________________
Last 3 digital numbers behind the card on the signature
sticker right hand _________________
Expiry date
_________________________________________________________
Passport number
____________________________________________________
Nationality _________________________________________________________
Issue at
___________________________________________________________
Signature as it appears on the card
__________________________________