Nepal Mountain Trekking: Nepal trip application form, Booking and payment information form, Name, Sex, Street address, City of Born, Sate, Birth date, Nationality, Passpor number, Profession, Everest trekking, Nepal Annapurna trek, Langtang trekking, Rafting, Chitwan wildlife Safari, Rafting and Kayaking, Wildlife safari, Off road motorbiking, Tibet tours and treks

Advance Payment Through Credit Card (Visa/Mastercard)

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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 Nepal Mountain Trekking 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 scan or take photo 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

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