Billing Address : _____________________________________________________________

 __________________________________________________________________________

Country : ________________________ Zip Code : ________________________________

Email Address ________________________________

I hereby authorize Sby leisure Travel and Tours to charge:

Amount in Thai Baht _____________________

( ) Visa Card         ( ) Master Card       

***The Last three digit number appearing on the signature panel

Cardholder's name ( as appears on credit card )__________________________________

_______________________________________________________________________

Expiry date (mm/yy) _______________________________________________________

Comments :______________________________________________________________

_______________________________________________________________________

Signature of Cardholder: ___________________

                Date : ___________________