High Mountain Wave Trekking - Payment by credit Card form

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Alpine Travel Service P. Ltd.                                                                  Date:………..............
Credit Card Centre
Durbar Marg, Kathmandu
Nepal

Dear Sir,

Authorization for the Payment by credit Card

I would like to pay US$…………… for the Advance of………………………..…......
to High Mountain Wave Trekking Pvt. Ltd. by VISA / MasterCard. The necessary details for this transaction are as below:

Card Number …………………………………………………............................................................
Expiry Date …………………………………………………...........................................................…
Amount ……………………………………………….……….............................................................
Identification Number……..…....…………….............................................................................
Billing Address ......................................................................................................................

Kindly receive the copy of my credit card (both-side) and the copy of my identification along with this request Letter (please fax the photocopy of credit-card both side and your passport for identification)

Thank you for your kind co-operation.
Regards,


Signature of the Cardholder
………………………………….........................................................
Name of the Cardholder…………………………………………......................................................
Nationality of the Cardholder……………………………………....................................................
Passport number…………………………………………………...................................................….
Address (Card holders’)…………………………………………......................................................
Telephone…………………………………............fax…………………............................................
E-mail…………………………………….…….................................................................................
Confirm me, when you receive this :- By email or by fax