Authorization for the Payment by Credit Card

I would like to pay US$. ……… for the advance of. ……………………..…. to S. Asia Travels (P.) Ltd. 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 S. Asia Travels (P.) Ltd. 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

S. Asia Travels (P.) Ltd.
P.O.Box: 23092, Thamel, Kathmandu, Nepal.
Tel: +977 98510 65354
Fax: +977 1 4260670
Email: sasia@abodehimalaya.com