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Nepal trip Accept Visa Card and Master Card

I would like to pay US$. …………… for the advance of ………………………..…………..  
to Trekking Team Nepal Pvt. Ltd.  by my VISA / MASTER CARD. The necessary details for this transaction are as below:
 
Card Number :
 
Card Expiry Date :
 
Amount in Words :
 
Date of Birth :
 
Passport Number :
 
Card Holder Full Name :
 
Address (Home/Office) :
 
 
Kindly send the copy of my passport and both side credit card along with this authorization form.
 
 
Signature of Cardholder _________________ Date: ---------------------
 
 
Privacy: All information contained herein is used solely by Trekking Team Nepal for purposes of charging on your credit card and will not be released under any circumstances.

Note: Please add 3 % extra bank charge on credit card payment.
 
 
Please fax this authorization form at +977-1-4228163 or by e-mail with scan (
trekteam@mail.com.np)