Confirmation/Payment

Full Name (*):

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).

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