Payment Form

Today's Date:
  • Please print out ,complete the form and send them back to us.
  • Please have your credit card ready to fill out the form.
  • Name and address must be the same as given to the credit card company
  • Click here to print this form.
Name of Buyer:
Address Line 1:
Address Line 2:
Tel Number:
Fax Number:

Detail of product purchased-tailored clothes.
I authorize Henry Fashion to charge my credit card.

Credit Card: VISA
Card Number:
The last three-digit number appearing on the signature panel. (VISA/Master)
For The four-digit number appearing on the right corner of the card ( AMEX)
Cardholder Name:
Expiry Date: Month:  Year:
Amount(Thai Baht) - THB:
Cardholder Signature: ____________________________________________
Return-refund Policy=No Refund
Delivery Process=Airmail.
Approval Code