Date:-			FAX No:-
			Email:-
Alpine Card Service P/L
Durbar Marg
Kathmandu,Nepal
Dear Sir/Madam
	RE:- Authorization For The Payment By Credit Card
	I would like to pay USD/NR for the purchase of to M/S Merchant ID No:- by my Visa/Mastercard.The necessary details for this transaction are as below:
Card Number
Card Expire Date
Amount in figure
Amount in Words
I.D number (P.P or I.D)
C\H's Date Of Birth
Statement Address
	Kindly receive the copy of my credit card (both side) and the copy of my identification (passport) along with this request letter.
	Thank you for your kind co-orperation.
Regards
Signature Of Cardholder
Name Of Cardholder
	*Note: please verify amount