** * Payment Through Fax Credit Card Payment. Please fill up the Following credit card information and Fax us in this no: 009771-4438458. For Security reason, you also have to send us your Passport or Driving Liscen or ID Card and alsothe picture of front and back side of your credit card.
--------------------------------------------------------------------------------------------------------------------------------------------- ATTN: BANDANA CONTACT TEL. NO.:
I hereby authorize Khukuri Palace Trade to debit from my card account for the payment against the purchase of .............
Following is the details of my card and transaction amount
Name:
Card no.:
Exp. Date:
Passport No.:
Amount:
--------------------------------------------------------
(Signature of the cardholder as appears on credit card) I will agree to pay amount in full as indicated above
Thank you
(P.S. Please fill up the above form, print it from your computer, sign it
and fax us by calling 0097714438458 )
Note: Additional 3.5% in total bill as bank service |