Confirmation/Payment

Active Holidays Indochina

Full Name (*):
Confirmation/Payment
Your Email (*):
Personal Information:
AHI No. (if any):
Phone (*):
Address:
City:
Area Code:
Country:
Gender:
Male
Female
Reference AHI Quotation:
Date of birth:
Year:
Day:
Month:
Yes, I would like to receive AHI newsletter.
Security Code(*):
Newsletter:
Fields marked with (*) are required. A copy of this request will be automatically sent to your email.
Fax:
Payment Details:
(Note: All bank fees are at the Client’s charge)
Payment Method:
Credit Card
Bank Transfer
Card Type:
Bank name: BIDV Binh Thuan Branch - Vietnam
Address: 286A, Tran Hung Dao Street, Phan Thiet City
Binh Thuan Province, Vietnam
Swift code: BIDVVNVX611 | CIF: 3461968
Account number (USD): 61110370010468
Beneficiary: AHI Co., Ltd.
Address: 84, Nguyen Dinh Chieu Street, Phan Thiet City
Binh Thuan Province, Vietnam
(Please mention, in the message, our quotation number for our follow up)
Debit the total amount:
Credit Card Number:
Card Holder's Name:
Credit Card Bank Name:
Expiry Date:
Month:
Year:
Last 3 digits security code:
(Printed at the back of your credit card)
Note:
- Your booking will be valid only after AHI receives the payment as detailed in the quotation.
- Our web server implements authentication and encryption using the Secure Socket Layer (SSL).