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APPLICATION THROUGH FAX FOR PAYMENT BY CREDIT CARDS Date:................................................ Subject: Authority to process credit card transaction through Fax. Dear Sir, I hereby authorize following merchant to process transactions as detailed below. Merchant Name : - Samrat Holidays Card Holder Details: Cardholder Name :.................................................................................... Card Number :........................................................................................... Expiry Date :............................................................................................. CVV Number :........................................................................................... (3 digit printed number in the signature panel of card) Transaction Amount :..............................................(USD/INR./NRS.) Passport Number :................................................................................. Billing Address :...................................................................................... Contact Address :................................................................................... Phone No :.............................................................................................. Fax No :................................................................................................... Email ID :................................................................................................ Disclaimer: Note: Copy of Passport, Copy of front and backside of card should be enclosed here with. Sincerely, |
