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(Complete
information please)!
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|
Date:
.........
|
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Authorization for the Payment by credit Card
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Dear Sir,
|
I would like to pay US$ / INR
for the Advance
of
..
......
to ECOLOGICAL TREKS Pvt. Ltd. by VISA / MasterCard /
American Express. The necessary details for this transaction
are as below:
| Card
Number
............................................................ |
| Expiry
Date
...........................................................
|
| Amount
.
............................................................. |
| Billing
Address
..
.............................................................. |
| ............................................................................................................................................. |
Kindly receive the copy of
my credit card (both-side) and the copy of my identification
(Passport) along with this request Letter.
Thank you for your kind
co-operation.
Regards,
| Signature
of the Cardholder
......................................................... |
| Name
of the Cardholder
...................................................... |
| Nationality
of the Cardholder
.................................................... |
| Passport
number
...................................................
. |
| Arrival
date in Kathmandu
..
................................................
... |
| Address
(Card holders)
...................................................... |
| Telephone
............fax
............................................ |
| E-mail
.
................................................................................. |
| Confirm
me, when you receive this :- By email or by fax
or by Tel. or by telex |
|
.......................................
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Operated under license and permit
from H.M. G. of Nepal. References upon request
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Return to Form
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