APPLICATION THROUGH FAX FOR PAYMENT BY CREDIT CARDS
Date:................................................
The Manager
Nabil Bank Ltd.
Durbar Marg, 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 Tours & Travels Pvt. Ltd.
Account No. (NPR):- 0101011754301
Account No. (USD):- 0104211754301
Name of Bank: - Nabil Bank Limited.
Sift Code: - NARBNPKA
Tel :- 00977-1-4004700, 4004701, 4004702, 4004703
Fax:- 00977-1-4004704
Merchant Address :- Gairidhara, 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
Download for Payment by Credit Card