Credit Card Payment Form

Please print out this form, then fill it out completely and fax it to Wayfarers Travel, (please also fax a photocopy of your passport - photo & signature pages).

Fax Number: (6653)279423 (if you are outside of Thailand)
(053)279423   (within Thailand)

I hereby authorise Wayfarers Travel to charge the sum of


to my      Visa [    ]           Mastercard [    ]           JCB [    ]


In payment of:   Tour Services [    ]         Accommodation [    ]


Hotel or Tour Service Dates: ____________________

Booking Number: ______________________

Cardholder Name (exactly as it appears on the card)  
Card Number (ie. xxxx xxxx xxxx xxxx )  
The last 3 Digit Number appearing on the signature panel  
Expiry Date ( MM/YY)  
Cardholder's Billing Address  
Cardholder's Passport Number & Nationality  
E Mail Address  
Telephone Number  
Fax Number  
Payment of deposit is confirmation of your tour with Wayfarers Travel. Booking and confirming your tour means you have read and agree to abide by the Terms and Conditions set out by Wayfarers Travel.
Signature (as it appears on card)  
Date (of filling out & signing form)  

Print out this form, then fill it out completely and fax it to Wayfarers Travel. Please fax a photocopy of your passport (photo & signature pages) along with the form; Thai commercial banks require this documentation.

Our fax number is: ++ 66 53 279423  (outside of Thailand)
                                (053)279423      (within Thailand)

OR  ++66 53 208276  (outside of Thailand)
        (053)208276       (within Thailand)

Payments are credited to our account in Thai Baht. You will be billed in your credit card statement, in your local currency. There might be slight price discrepancies according to the current exchange rate when the transaction takes place.

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Copyright 1998-2002 Wayfarers Travel  All rights reserved.

Last updated: 10/08/02 17:21:18