NepalAccommodation.Com

CREDIT CARD PAYMENT AUTHORIZATION

Payment Faxed

   Transaction Date:
I / We,    authorize to Ghale Treks & Expedition - Tours & Travels (NepalAccommodation.com) Pvt., Ltd. of 29-Bhagawoti Sthan, Thamel, Kathmandu, Nepal.
to charge the sum of :

(please indicate currency)

(in letters)
TO: Visa Card
 Visa		  Master Card
 Master Card		  
Paypal - Click to Buy Now Bottom
Card Number :               Expiry Date :
Please fill in the last three-digit number (for VISA card) or four digit number (for AMEX) appearing on signature panel:
(What is the Secure Number?)

My name as appear on the card is :

The above mentioned charge is for :

Card Holder’s Signature :
_________________________
Date:
Cardholder's Passport No :
Cardholder's Address :
Cardholder's Tel. No : Country Code   No
Cardholder's Fax No : Country Code   No
Instructions on How to Use This Form:
1) Kindly fill your credit card type, card number, name on card, expiry date, plus the last 3 or 4 digits on the back of your card (depending on your card type)
2) Print out the form and verify that all details are correct, then please sign your name on the "Card Holder's Signature" line
3) Fax authorization form, along with copy of the credit card on both sides at: (+977-1) 443 -7187
4) Please also fax a copy of passenger's passport (the page with picture and passport holder information)
You will not be charged until your room has been confirmed. All charges will be noted in the confirmation email that you will receive immediately after your booking request has been confirmed.
 Please print...