Phuket Adventure Club Co,Ltd
TAT License No.PK 33/ 1682 )
Signature-On-File / Authorization

  • Due to safety reasons we accept credit card payments by fax. Please follow
    the instructions given below.
  • Please download this form as MS Word or text file and print out, fill it in, sign
     
  • Photocopy your credit card front and back sides. Fax the copy of your credit card
    with this signed Authorization form to our Fax: 076 383859


Cardholder's name___________________________________________________________

Billing Address : _____________________________________________________________

 __________________________________________________________________________

Country : ________________________ Zip Code : ________________________________

I hereby authorize   Phuket Adventure Club co.,Ltd.  to charge:

Amount in US$ ___________________ or in Thai baht ______________________________

( ) Visa Card ( ) Master Card

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

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

_______________________________________________________________________

Expiry date ( dd/mm/yy ) ____________________________________________________

Comments :______________________________________________________________

_______________________________________________________________________

Signature of Cardholder: ___________________

                Date : ___________________


Phuket Adventure Club Co.,Ltd.
(TAT License No.PK 33/ 1682 )

46/20 Ao Chalong Pier, Moo9, T.Chalong
A.Muang, Phuket 83000 Thailand
Tel. 076 383340-1, 076 383860-1 Fax: 076 383859
Email