Authorization for the Payment by Credit Card
I would like to pay US$. ……… for the advance of. ……………………..…. to Adventure Treks Nepal P/L by my VISA / MASTER CARD. The necessary details for this transaction are as below:
Card Number:
Card Expiry Date:
Amount in Words:
Cardholder’s Date of Birth:
Passport Number:
Card Holder Full Name:
Address (home/office):
Kindly receive the copy of my passport along with this authorization form.
Signature of Cardholder _________________ Date: ---------------------
Privacy: All information contained herein is used solely by Adventure Treks Nepal for purposes of charging on your credit card and will not be released under any circumstances.
Note: Please add 4% extra bank charge on credit card payment. Send Passport copy & credit card copy.
Please fax this authorization form at +977-1-4260670
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