Note: Please fill up complete information in online and print than send us it by Fax or E-mail.
Date:
 
Authorization for the Payment by credit Card
Dear Sir,
I / We would like to pay US$ for the Advance of
To
by VISA Master Card.
 
The necessary details for this transaction are as below:
Card Number
Expiry Date
Amount.
Billing Address
Kindly receive a copy of my credit card (both-sides) 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 :
 
Please will you confirm, when you receive this: - By email
 
 


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