CREDIT CARD AUTHORIZATION FORM - Get as DOC

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					                     CREDIT CARD AUTHORIZATION FORM
Bayon Heritage Holding Group Co., LTD
#14 Eo, Street 51 (Pasteurs), Sangkat Beng Keng Kang I, Khan Chamkamorn,
Phnom Penh, Kingdom of Cambodia.
Tel: (855)-23 997178-23 223299 Fax: (855)-23 223299

* For safety reasons, we would like to recommend that the credit cards payment should be done by
facsimile to our above office fax number.

Payment Mode and Procedures:

   1.    Please print out this credit card authorization form
   2.    Filling and Signing this authorization form
   3.    Copy your front & back of your credit card and passport of the holder.
   4.    Afterward, Fax all these documents (Authorization form, copies of credit cards, passport) to
         our office fax number (855)-23 223 299.

                               CREDIT CARD AUTHORIZATION FORM

1. Cardholder’s Name : _______________________________________________________________

2. Home Address        : _______________________________________________________________

                           _______________________________________________________________

3. Country             : _________________________

4. Zipcode             : _________________________

I hereby authorize Bayon Heritage Holding Group Co., LTD to charge me following amount from
my credit card account:

Amount in USD          : __________________________ (The total amount + 3% of Bank Charge)

Inword                 : _______________________________________________________________

                           _______________________________________________________________

on my credit card      :       Visa Card         Master Card

Card Number            : ______________________________

Date of Expire         : ______________________________

For the services       : _______________________________________________________________

                           _______________________________________________________________


Signature of Card Holders      : ___________________________ Name : ______________________

                                                                    Date : ______________________

                                           For Official Use Only

   Approval Code       : _________________________ Amount in USD : _____________________

				
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