Credit Card Payment

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

Download this form

For Detail: advnepal@wlink.com.np