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Payments by Credit Card

Date:................................................
The Manager
Card Centre
Nepal Investment Bank Limited
Putalisadak, Kathmandu, Nepal.
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
Merchant No :- 012000184
Account No. (NPR):- 2614800
Account No. (USD):- 012-2614800
Branch code: - 012
Name of Bank: - Nepal Investment bank Ltd.
Sift Code: - NIBLNPKT
Tel :- 00977-1-4700397/4701351
Fax:- 00977-1-470226
Merchant Address :- Thamel, Kathmandu , Nepal
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:I kindly request you to process above-mentioned transaction. I hereby agree and accept that I have fully read and agreed the terms and conditions for the purchase of goods/ services through this transaction and I hereby indemnify merchant and Nepal Investment Bank Limited for any disputes arising by virtue of this transaction. The card has been issued in my name and I am the authorized user.
Note: Copy of Passport, Copy of front and backside of card should be enclosed here with.
Sincerely,
......................................................................
Signature
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