I would like to pay US$. …………… for the advance of ………………………..…………..
to Trekking Team Nepal Pvt. Ltd. by my VISA / MASTER CARD. The necessary details for this transaction are as below:
Card Number :
Card Expiry Date :
Amount in Words :
Date of Birth :
Passport Number :
Card Holder Full Name :
Address (Home/Office) :
Kindly send the copy of my passport and both side credit card along with this authorization form.
Signature of Cardholder _________________ Date: ---------------------
Privacy: All information contained herein is used solely by Trekking Team Nepal for purposes of charging on your credit card and will not be released under any circumstances.
Note: Please add 3 % extra bank charge on credit card payment.
Please fax this authorization form at +977-1-4365493 or by e-mail with scan (trekking@mail.com.np)
