Credit Card Online Form
SCB Internet Payment System (SIPS)
Important!! Please furnish full name
First Name :
Last Name :
Important !! Pls furnish complete e-mail address so that our reply could reach you
Email : (Correspondence E-mail address)
Address :
City :
Province/State :
Zip Code :
Country :
Phone :
Fax :
Description of Service : (Hotel Name, Tour, Package, Air Ticket, etc.)
Reservation Number : digit only (i.e. 9999)
Period : (dd/mm/yy - dd/mm/yy) No more than 20 valid number
Amount pay : digit only (i.e. 9999)
Currency :
Please contact us if you encounter any difficulties sending this form.