Date:
The Manager
Card Centre
………………………………………..
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 :
Merchant No :
Merchant Address :
Cardholder Name :
Card Number :
Expiry Date :
CVV/CVC Number :
Transaction Amount : U.S. $./ INR.₹/ Rs.
Passport Number :
Country :
Billing Address :
Contact Address :
Phone No :
Mobile 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 …………………………………………………. for any disputes arising by virtue of this transaction. The card has been issued in my name and I am the authorized user.
Note: Please kindly send us Copy of Passport, Copy of front and back side of card
Sincerely,
……………………………………..
Signature
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