CREDIT CARD AUTHORIZATION FORM

I,    authorize Quality Express Co., Ltd. of 1111/30/31, 1-2th Floor, Lard Prao Road, Chankasam, Chatuchak, Bangkok 10900
To charge the sum of : (please indicate currency) (in letters)
TO: Visa Card
 Visa		  Master Card
 Master Card

Card Number :               Expiry Date :
Please fill in the last three-digits (for VISA and Mastercard) appearing on signature panel: (see example)

My name as appear on the card is :
The above mentioned charge is for (please indicate name and booking details):
 

Card Holder's Signature : __________________________

Date:                                    

Cardholder's Passport No :


Cardholder's Address :
Cardholder's Tel. No :        
                       (Country code)(Area code) (Number)
Cardholder's Fax. No :        
                       (Country code)(Area code) (Number)

print
 
Instructions on How to Use This Form:
1) Kindly fill your credit card type, card number, name on card, expiry date, plus the last 3 or 4 digits on the back of your card (depending on your card type)
2) Print out the form and verify that all details are correct, then please sign your name on the "Card Holder's Signature" line
3) Fax this authorization form, along with a copy of both sides of the credit card to Qetour.com reservations department at: (662) 511-0015
4) Please also fax a clear copy of passenger's passport (the page with picture and passport holder information)