WEEKENDER TRAVEL AGENCY LTD., PART.

124/323 MOO 3, LAMAI BEACH, KOH SAMUI

84310 SURATTHANI, THAILAND

TEL./FAX.: (077) - 424225

info@weekender-travel.de

payment in deutsch

I allow, the Weekender Travel Agency, Lamai Beach, Koh  Samui - Thailand, for payment, the following amount, to take from my credtcard.

 

please fill out the form with the computer and print this out

first name

 

family name

 

passport number

 

remarks

cardnumber ( 16 digit !!)

  3 digit number (backside)

(Euro/Master/Visa/...)

bank exhibitor

 

valid until (05/08)

 

please fill out in Thai-Bath only

 THB

your signature

date:

 

please send a copy from your passport and this form to Fax 0066 77 424225.