Date:....................
Himalayan Bank Limited
Credit Card Centre
Lalitpur, Nepal
| Dear Sir, |
Authorization for the Payment by credit Card |
I would like to pay US$…………… for the Advance of............................................. to WhiteWater Nepal Pvt. Ltd. by VISA/MASTER card.
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 |
|
