DATE: ..............................

Himalayan Bank LTD.
Credit Card Center
Pulchok, Lalitpur
Nepal

Dear Sir/Madam,

RE: AUTHORISATION FOR THE PAYMENT BY CREDIT CARD

I would like to pay US$¡­¡­¡­¡­¡­. For the Advance Booking Payment of ¡­¡­¡­¡­¡­¡­.. To M/S Mountain Sherpa Treks & Expedition P.LTD (US$ A/c No. 36304A0) By My VISA/MASTER Credit Card/Debit Card. The Necessary Details for This Transaction re as follows:

CARD DETAILS:
Card Number:¡­¡­¡­¡­¡­
Expiry Date:¡­¡­¡­¡­¡­¡­..
Amount: US$¡­¡­¡­¡­¡­¡­
Billing Address:¡­¡­¡­¡­.

PERSONAL DETAILS:
Name of Card Holder:¡­¡­¡­¡­..
Signature of Card Holder:¡­¡­¡­¡­¡­..
Nationality:¡­¡­¡­¡­¡­..
Passport No or Identification No:¡­¡­¡­¡­.
Telephone No:¡­¡­¡­¡­
Fax No:¡­¡­¡­¡­
E-mail:¡­¡­¡­..
Address:¡­¡­¡­¡­¡­¡­¡­¡­..

Note: Kindly receive the Copy of My Credit/Debit Card (Both Side) and copy of my identification (passport) along with this request letter/Form.

Thank you for your kind Co-operation.

Regards, ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­
Signature of Card Holder
Name of Card Holder: