CREDIT CARD FORM
Your Credit Card is Safe with IndochinaTour.com

Mono Travel Co., Ltd

Please debit (Amount) ................................................................... Baht

Against Credit Card : ..............................................................
[ VISA, MASTER, AMEX, DINERS CLUB or JCB]

Credit Card No. .............................................................................

Cardholder Name : .........................................................................

Expiry date : ................................................................................

Please advise the last three-digit number or four digit number (for AMEX)
appearing on signature panel (if any) : .................................. (See example)

For payment of : ..........................................................................

Hotel name : ............................................................................

Guest name : ............................................................................

E-mail address : ............................................................................

Signature of Cardholder : ...............................................................

Date : ........................................................................................

*********************** IMPORTANT **********************

Please kindly print this form, fill-in your detailss and fax it back to our Bangkok Office at (662) 584 5204 Attention Reservation Department